Effects of rhomboid intercostal nerve, serratus anterior plane, and paravertebral block on the quality of recovery after breast cancer surgery: a randomized controlled clinical trial

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BACKGROUND: Nerve blocks are one of the most important methods of postoperative analgesia in breast cancer surgery. We used a randomized controlled clinical trial to compare the effects of rhomboid intercostal nerve block, serratus anterior plane block, and paravertebral block on the quality of recovery and postoperative analgesia in modified radical mastectomy. METHODS: We used a randomized controlled clinical trial to compare the effects of rhomboid intercostal nerve block, serratus anterior plane block, and paravertebral block on the postoperative quality of recovery and postoperative analgesia in modified radical mastectomy. A total of 132 breast cancer surgery patients were randomized 1:1:1 into three groups. 0.375% ropivacaine 20 ml for ultrasound-guided rhomboid intercostal nerve block group (n = 44), serratus anterior plane block group(n = 44), and paravertebral block group (n = 44). The primary outcome was the quality of the recovery-40 questionnaire (QoR-40 score). RESULTS: The postoperative 24-hour QoR-40 scores of the rhomboid intercostal nerve block group (median: 186; interquartile range: 177, 190.5) and the paravertebral block group (median: 186.5; interquartile range: 176.25, 190.5) were not statistically significant. The serratus anterior plane block group (median: 168; interquartile range: 163.25, 172) had significantly lower QoR-40 scores than the paravertebral block group (median difference: -17, 95%CI: -20, -13; P < 0.001). Furthermore, the rhomboid intercostal nerve block group had significantly higher global QoR-40 scores than the serratus anterior plane block group (median difference: 17, 95%CI: 14, 20; P < 0.001). In addition, the intraoperative sufentanil consumption (P < 0.001), number of intraoperative sufentanil users (P < 0.001), and postintubation NRS scores (P = 0.01) of the rhomboid intercostal nerve block and paravertebral block group were significantly lower than those of the serratus plane block group, but there was no statistically significant difference between the rhomboid intercostal nerve block and paravertebral block group. There was no statistically significant difference between the three groups in postoperative numerical rating scale scores, postoperative tramadol consumption, adverse events, and average length of stay. CONCLUSION: Rhomboid intercostal nerve block and paravertebral block were able to provide similar analgesic effects and QoR-40 scores in breast cancer surgery. However, the blocking effect of the serratus anterior plane block was inferior to the rhomboid intercostal nerve block and paravertebral block. Rhomboid intercostal nerve block may be one of the best alternatives to paravertebral block as a fascial plane block. TRIAL REGISTRY: Chinese Clinical Trial Registry ChiCTR2300079196. Registered on 27 December, 2023.

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