Is the serratus posterior superior intercostal plane block a viable alternative to the erector spinae plane block for postoperative analgesia in breast surgery? A prospective, randomized trial

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BACKGROUND: Effective management of postoperative pain remains a significant challenge after breast surgery. Among the available strategies, regional nerve blocks play a key role in alleviating surgical pain in these patients. This study was aimed to evaluate and compare the analgesic efficacy of two regional techniques-erector spinae plane block (ESPB) and serratus posterior superior intercostal plane block (SPSIPB)-in patients undergoing breast surgery. METHODS: This study included 50 female patients aged 18 to 65 years, classified as ASA physical status I-III, with a body mass index ranging from 18 to 35 kg/m², who were scheduled to undergo unilateral breast cancer surgery. Based on random group allocation, either ESPB or SPSIPB was administered before the induction of general anesthesia. Postoperative analgesia was provided using a tramadol-based patient-controlled analgesia (PCA) system. Pain intensity was assessed with the visual analog scale (VAS) at specific predetermined time points: immediately postoperatively (0 h), and at 1, 4, 8, 12, and 24 h. The primary outcome was postoperative pain intensity assessed using the VAS at predetermined time points. Secondary outcomes included total opioid consumption via PCA, requirement for rescue analgesia, incidence of postoperative nausea/vomiting (PONV), block performance time, side effects, and patient satisfaction. RESULTS: There were no significant differences in VAS scores at rest or during coughing between the two groups at any of the assessed postoperative time points (0, 1, 4, 8, 12, and 24 h) (p > 0.05). A statistically significant difference in postoperative tramadol consumption was observed between the groups, with the ESPB group receiving 137.6 ± 124 mg and the SPSIPB group receiving 82.4 ± 102 mg via PCA, corresponding to an average reduction of 55.2 mg in the SPSIPB group (p = 0.044). The difference in consumption was due to the difference in consumption between 4 and 8 h. In the ESPB group, the average tramadol consumption during this period was 75.2 mg, while in the SPSIPB group, it was 36.8 mg (p = 0.007). No significant differences were found between the groups regarding PONV, side effects, patient satisfaction, and duration of blocks. CONCLUSIONS: The SPSIPB may provide postoperative analgesia that is comparable in efficacy to the ESPB technique in breast surgery. Based on the findings of this study, SPSIPB provided postoperative analgesia comparable to ESPB and was associated with lower opioid consumption within the first 24 h after surgery. Furthermore, the ESPB group experienced pain relief earlier after surgery compared to the SPSIPB group, while pain relief in the SPSIPB group occurred later and lasted longer.

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