“COMPARATIVE EFFICACY OF LEVOBUPIVACAINE AND ROPIVACAINE IN ULTRASOUND GUIDED SERRATUS ANTERIOR PLANE BLOCK FOR PATIENTS UNDERGOING UNILATERAL BREAST SURGERIES: A RANDOMIZED CONTROLLED TRIAL

Breast cancer is increasingly becoming the most common cancer among the females in India.  It accounts to around 25-32% of all female cancers in India as per National Cancer Registry1. Advances in Oncology has led to effective treatment in breast cancers.

 Breast cancers requires various surgical interventions like lumpectomy or mastectomy with axillary lymph node clearance. General anaesthesia is the conventional, most frequently used anaesthetic technique. Various regional anaesthetic techniques interventions have also been used for breast surgeries; these include local infiltration, thoracic epidural anaesthesia, thoracic  paravertebral blocks, thoracic spinal anaesthesia, and more recently, ultrasound guided interfascial plane blocks such as Pectoral nerves ( PECS ),  type 1 and  type 2, Serratus anterior plane block. Although the beneficial effect of regional anaesthesia is well known, data are emerging for other potentially beneficial effects of regional anaesthesia and analgesia on other perioperative outcomes. Those include decreased need of opioid analgesics for post-operative pain management, decreased post-operative nausea and vomiting (PONV).

 Serratus anterior plane block was described by Fajardo as a new ultrasound guided technique. Local anaesthetic is injected between serratus anterior and external intercoastal muscles in the mid-axillary line to block the lateral cutaneous branches of the intercoastal nerves mainly from T2-T9 before dividing into anterior and posterior branches. On injection of local anesthetic at this level also blocks the thoracic and thoracodorsal nerves.

 The long-acting local anaesthetics viz., Ropivacaine and Levobupivacaine have been developed after the evidence of bupivacaine-related severe toxicity. Both these agents are pure left-isomers and, based on their three-dimensional structure; they have less toxic potential both on the central nervous system and on the heart.  Although levobupivacaine is theoretically more potent than ropivacaine, clinical studies show conflicting results in terms of anesthetic and analgesic characteristics. Studies on various nerve blocks have shown that equipotent doses of ropivacaine and levobupivacaine have similar efficacy in peripheral nerve plexus blocks2. However, no study is available in the literature comparing the relative efficacy of these drugs in Serratus anterior plane block.

 This study is conducted to assess the comparative efficacy of Inj. Levobupivacaine and Inj. Ropivacaine in Serratus anterior plane block as a part of  multimodal analgesia inpatients undergoing unilateral breast surgeries under general anaesthesia.