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. 2020 Nov 12:13:2885-2894.
doi: 10.2147/JPR.S274808. eCollection 2020.

Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial

Walaa Y Elsabeeny  1 , Nahla N Shehab  1 , Mohamed A Wadod  1 , Mostafa A Elkady  1
Affiliations

Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial

Walaa Y Elsabeeny et al. J Pain Res. .

Abstract

Purpose: Various analgesic modalities are adopted for perioperative analgesia in breast cancer surgeries. This study aimed to compare the efficacy of intravenous morphine versus serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in breast cancer surgeries.

Patients and methods: Seventy-five breast cancer patients undergoing modified radical mastectomy from January 2020 to June 2020 were randomly allocated into 3 groups; the morphine group received morphine 0.1 mg/kg, the SAPB group received ultrasound-guided SAPB with 25 mL bupivacaine 0.25% and the ESPB group received ultrasound-guided ESPB with 25 mL bupivacaine 0.25%. A visual analogue scale (VAS) 0-10 was used to evaluate pain postoperatively, where 0 denotes no pain and 10 worst pain. If any patient in the 3 studied groups reported breakthrough pain with VAS ≥ 4 then a bolus of 3 mg morphine was given.

Results: There was no difference in VAS scores between the 3 groups postoperatively. Morphine consumption was higher in the morphine group (9.19 ± 2.32 mg) than the SAPB group (4.00 ± 1.55 mg) and the ESPB group (4.20 ± 1.64 mg), respectively. First time to receive postoperative morphine was significantly longer for the ESPB and SAPB groups than the morphine group (20.40 ± 4.98 hours), (19.00 ± 5.9 hours), (5.00 ± 4.62 hours), respectively. Intraoperative hemodynamics and fentanyl consumption showed no difference between groups, whereas postoperative mean arterial blood pressure values at 2 and 4 hours were higher in the morphine group. Ramsay sedation score and postoperative nausea and vomiting values in the post anesthesia care unit were higher for the morphine group compared to the SAPB and ESPB groups. No complications related to the blocks were reported.

Conclusion: SAPB and ESPB can be used as an effective and safe alternative to opioids with fewer side effects in breast cancer patients undergoing modified radical mastectomy.

Trial registration: This trial was prospectively registered at Clinical Trials.gov on 22 January 2020 with registration number NCT04248608 (https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JS5&selectaction=Edit&uid=U0004LIG&ts=7&cx=-81xkwa).

Keywords: erector spinae block; modified radical mastectomy; morphine; serratus plane block.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Serratus anterior plane.
Figure 2
Figure 2
Erector spinae plane.
Figure 3
Figure 3
Postoperative analgesic protocol. IV, intravenous; VAS, visual analogue score.
Figure 4
Figure 4
Consort flow diagram. IV, intravenous; SAPB, serratus anterior plane block; ESPB, erector spinae plane block.
Figure 5
Figure 5
Preoperative and intraoperative heart rate. HR, heart rate; BPM, beats per minute.
Figure 6
Figure 6
Preoperative and intraoperative mean arterial blood pressure (MAP).
Figure 7
Figure 7
Postoperative heart rate. HR, heart rate; BPM, beats per minute; SAPB, serratus anterior plane block; ESPB, erector spinae plane block.
Figure 8
Figure 8
Postoperative mean arterial blood pressure (MAP). SAPB, serratus anterior plane block; ESPB, erector spinae plane block.
Figure 9
Figure 9
Postoperative visual analogue scores (VAS). SAPB, serratus anterior plane block; ESPB, erector spinae plane block.
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