Post Operative Analgesic Efficacy Of Erector Spinae Plane Block VS Serratus Anterior Plane Block In Patients Undergoing Modified Radical Mastectomy

Introduction: Postoperative pain relief following modified radical mastectomy is usually achieved with a combination of systemic opioids and non-opioid simple analgesics. Variable efficacy of pain relief and opioid associated side effects are major limitations with significant impact on the quality of postoperative recovery.
Objectives: To compare the analgesic efficacy of ultrasound-guided Erector Spinae Plane Block (ESPB) versus Serratus Anterior Plane Block (SAPB) in patients undergoing Modified Radical Mastectomy (MRM) in terms of the efficacy and duration of analgesia and intraoperative analgesic requirements. Additionally, the incidence of postoperative nausea and vomiting (PONV) was also studied.
Study Design: A prospective comparative study was conducted over 12 months. Sixty female patients aged >18 years with ASA physical status I-III undergoing MRM were enrolled, with 31 in the ESPB group and 29 in the SAPB group. We evaluated the time to first rescue analgesia, intraoperative fentanyl requirements, postoperative pain scores, and the incidence of postoperative nausea and vomiting.
Results: Demographic characteristics were statistically comparable between the groups. The median time to first rescue analgesia was significantly longer in the ESP group (15 hours) compared to the SAB group (6 hours) (p = 0.01). Intraoperative fentanyl requirements were comparable between groups (ESP: 20±15 µg vs. SAB: 25±10 µg). Both groups showed similar incidence of PONV and antiemetic requirements.
Conclusion: Ultrasound-guided ESPB demonstrates superior analgesic efficacy compared to SAPB for MRM surgery, providing longer duration of analgesia and reduced intraoperative analgesic requirements. However, it was found that SAPB remains a valuable alternative, particularly when technical simplicity is prioritized or ESPB is contraindicated. Multi-centric studies are warranted with a larger sample size to generalize the findings due to the smaller sample size of the current study.