A Prospective randomized study to evaluate efficacy of Serratus Anterior Plane block in addition to multimodal analgesia for perioperative opioid sparing in patients undergoing modified radical mastectomy

Introduction:

Despite the implementation of novel surgical techniques and multimodal analgesia regimens,nearly 60% of breast surgery patients experience severe acute postoperative pain(1).

A poorly controlled perioperative pain management strategy on this surgical population, may result in delayed functional recovery, delayed post anesthesia care unit (PACU) discharge and/or extended length of hospital stay .In addition, inadequate postoperative pain management is recognized as one of the most relevant risk factors for the development of chronic postoperative breast pain(2). Serratus Anterior Plane (SAP)  block is a safe and effective method to treat postoperative pain after breast surgery(3). It  primarily targets the thoracic intercostal nerves (T2-T8), providing complete analgesia to the antero- lateral part of the thorax.There are few publications evaluating its effectiveness in conjunction with multimodal analgesia (MMA) in pain management and opioid sparing effect after modified radical mastectomy (MRM). Multimodal analgesia (MMA) is a strategy that aims to reduce reliance on opioids, and involves the use of two or more drugs that have different mechanisms of action to provide adequate analgesia. In the recent times there has been an increasing emphasis on use of multimodal analgesia (MMA), particularly in the context of postoperative enhance recovery after surgery (ERAS) protocols, reducing perioperative opioid consumption and, subsequently, their side effects(4). The use of oral gabapentinoids and acetaminophen alone or in conjunction with regional anesthesia as part of multimodal analgesia(MMA), has shown an adequate reduction on pain scores and opioid consumption(5). Therefore, our study hypothesized that the use of a serratus anterior plane (SAP) block in combination with multimodal analgesia (MMA) will reduce perioperative opioid consumption in patients undergoing modified radical mastectomy ( MRM).