An Open Approach Versus Ultrasound Approach for Serratus Anterior Plane Block for Postoperative Analgesia After Modified Radical Mastectomy: A Non-inferiority Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Mansoura University
- Enrollment
- 46
- Locations
- 1
- Primary Endpoint
- Morphine consumption given as a rescue analgesia
Study Overview
Brief Summary
Ultrasound-guided Serratus anterior plane (SAP) block is an interventional technique that recently gained popularity in the context of postoperative analgesia after breast surgery. Some limitations may be encountered during the use of ultrasound, such as obesity, tumor invasion of the surrounding muscles, which may lead to poor ultrasound image quality. The investigators hypothesized that an open approach to serratus anterior block by infiltration of local anesthetic between serratus anterior muscle and ribs after tumor excision during surgery would be non-inferior to ultrasound-guided approach where the primary endpoint of this prospective randomized blind controlled study will be the total dose of morphine consumed in the 1st postoperative 24 h. The patients will be randomly allocated to an open approach group and ultrasound approach group to serratus anterior block using computer-generated random numbers and sealed opaque envelops. For any statistical tests used results will be considered as statistically significant if P-value ≤0.05.
Detailed Description
Modified radical mastectomy (MRM) is one of the most common surgeries performed, and one that may be associated with significant acute postoperative pain in breast surgery. Acute postoperative pain is an independent risk factor in the development of chronic post-mastectomy pain.
Various regional anesthetic procedures have been tried to provide better acute pain control and, consequently, less chronic pain. They can reduce perioperative opiates requirement and thereby decreasing their possible side effects. These regional procedures include local wound infiltration, thoracic epidural, and thoracic paravertebral block (PVB). pectoral nerves block type-1 (PECSI), pectoral nerves block type-2 (PECS II), and serratus plane block.
Ultrasound-guided Serratus anterior plane (SAP) block is an interventional technique that recently gained popularity in the context of breast surgery. SAP block resulted in better hemodynamic stability, early ambulation, and reduced duration of hospitalization as well as hospital costs in postoperative breast patients.
Some limitations may be encountered during the use of ultrasound, such as obesity, tumor invasion of the surrounding muscles, which may lead to poor ultrasound image quality. Also, ultrasound use depends on equipment quality and investigator experience.
The investigators hypothesized that an open approach to serratus anterior block by infiltration of local anesthetic between serratus anterior muscle and ribs after tumor excision during surgery would be non-inferior to ultrasound-guided approach in providing analgesia to female patients undergoing modified radical mastectomy. The primary endpoint will be the total dose of morphine consumed in the 1st postoperative 24 h. secondary outcomes will be the time of the first analgesic request (duration of the pain-free periods after surgery in the1st postoperative 24 hours), postoperative visual analog score (VAS), postoperative modified Ramsay sedation score, and PONV (post-operative nausea and vomiting).
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to 60 Years (Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •American Society of Anesthesiologists (ASA) physical status scores of I and II
- •Elective unilateral breast surgery (modified radical mastectomy)
Exclusion Criteria
- •Patient refusal to participate in the study.
- •Allergy to any medications used in the study.
- •Patients with coagulopathy
- •patients with psychiatric disorders.
Arms & Interventions
ultrasound group
serratus anterior plane block will be done through ultrasound guidance
Intervention: ultrasound approach of serratus anterior block (Procedure)
Open group
serratus anterior plane block will be done after mastectomy through the open wound
Intervention: open approach of serratus anterior block (Procedure)
Outcomes
Primary Outcomes
Morphine consumption given as a rescue analgesia
Time Frame: Up to 24 hours after the procedure
The amount of morphinel consumption in milligrams given as a rescue analgesia to patients when the vas score is more than 3
Secondary Outcomes
- postoperative complications(Up to 24 hours after the procedure)
- Mean arterial blood pressure(Up to 24 hours after the procedure)
- visual analogue score (VAS) at rest(Up to 24 hours after the procedure)
- visual analogue score (VAS) at shoulder movement(Up to 24 hours after the procedure)
- The period for the first analgesic required(Up to 24 hours after the procedure)
- Heart rate(Up to 24 hours after the procedure)
Investigators
Mahmoud Mohammed Alseoudy
Lecturer of anesthesia, ICU & pain management; Faculty of Medicine
Mansoura University