Comparison of the Analgesic Effect of Superficial and Deep Serratus Anterior Plane Block in Patients Undergoing Radical Mastectomy for Breast Cancer

LIU Yan; DONG Jingjing; PEI Wenbo; XU Fangsheng; JIA Jintai; LI Chunyu

doi:10.3969/j.issn.2095-3097.2024.02.025

Abstract：Objective To evaluate the analgesic effect of superficial and deep serratus anterior plane block in patients undergoing surgery for breast cancer during perioperative period.Methods Sixty patients who underwent modified radical mastectomy for the first time under elective general anesthesia from August 2020 to July 2022 were selected and randomly di-vided into superficial anterior serrated muscle plane block group(group S),deep anterior serrated muscle plane block group(group D)and control group(group C),with 20 patients in each group.In group S and group D,the superficial and deep plane of the anterior serration muscle were identified under the guidance of ultrasound,20 mL of 0.5%Ropivacaine injection was injected,and the range of hypoalgesia was measured by acupuncture at 30 min after injection.Group C received general anesthesia directly.The mean arterial pressure(MAP),heart rate,intraoperative Remifentanil dosage,blood loss and dura-tion of operation of the three groups were recorded before anesthesia induction(T0),before incision(T1)and at 3 min after incision(T2).The quality of recovery before surgery,and at 24 and 48 h after surgery,visual analogue scale(VAS)scores immediately after extubation and at 2,6,12,24 and 48 h after surgery at rest and during cough were recorded in the three groups,and the number of remedial analgesia cases,adverse reactions and complications were recorded.Results Three ca-ses were excluded from Group S,and a total of 17 cases were included.Pain positive areas from the midline of the clavicle to the posterior axillary line,and at T3～T6 segments could be produced in both groups S and D,but did not exceed the anterior medi-an line.The number of positive cases in group D was more than that in group S in the same segment.Compared with group C,the MAP and heart rate at T2 in groups S and D were lower than those in group C,the intraoperative Remifentanil dosage,the number of remedial analgesia at 12 and 24 h after surgery were reduced,and the QoR-15 score at 24 h after surgery was in-creased(P<0.05).At rest,VAS scores in groups S and D immediately after extubation,and at 2 h,6 h,12 h and 24 h after surgery were lower than those in group C(P<0.05).During cough,the VAS scores of group S immediately after extubation,and at 2 h and 6 h after surgery were lower than those of group C,and the VAS scores of group D immediately after extubation,and at 2 h,6 h,12 h and 24 h after surgery were lower than those of group C(P<0.05).The VAS scores at 12 h and 24 h af-ter operation in group D were lower than those in group S(P<0.05).There was no significant difference in the incidence of ad-verse reactions among the three groups(P>0.05),and no serious complications occurred.Conclusion Both superficial and deep superficial and deep serratus anterior plane block can provide satisfactory analgesic effect during perioperative period for pa-tients undergoing surgery for breast cancer.Compared with superficial block,deep plane block is more likely to be established under ultrasound,which has fewer impacts on surgical operation,and has more significant postoperative analgesia effect.