A Comparative Study of Erector Spinae Plane Block and Serratus Posterior Superior Intercostal Plane Block on Postoperative Opioid Consumption Following Breast and Axillary Dissection Surgery

Summary

Breast surgery is one of the most common surgical procedures worldwide. Pain after surgery is an important issue because it affects recovery and mobility. It can also increase the risk of breathing problems.

Although opioids are effective for pain relief, they can cause side effects like nausea, vomiting, and breathing difficulties. These side effects can negatively impact patients and their recovery. Reducing opioid use is important for ensuring patient safety and improving the recovery process.

To manage pain after breast surgery, two types of nerve blocks can be used: the erector spinae plane block (ESPB) and the serratus posterior superior intercostal plane block (SPSIP). Both methods are effective for providing pain relief after surgery. However, there are not enough studies comparing which method is better.

Purpose of the Study: The main aim of this study is to evaluate the effect of ultrasound-guided ESPB and SPSIP blocks on opioid use after breast surgery. Additionally, we will compare opioid-related side effects (like nausea, vomiting, and breathing problems) and pain levels measured with the NRS (Numeric Rating Scale) between the two groups.

Conditions

• Breast Surgery
• Erector Spinae Plane Block
• Serratus Posterior Superior Intercostal Plane Block

Interventions

PROCEDURE

erector spinae plane block

the ESP block will be administered after surgery but before the patient is awakened, under sterile conditions and ultrasound guidance. Patient Positioning: The patient will be placed in the lateral position with the surgical side up, and a sterile ultrasound probe cover will be used. Ultrasound Imaging: A high-frequency (11-12 MHz) linear probe will be placed transversely at the T5 thoracic vertebra. Anatomy Identification: The erector spinae muscle and transverse processes will be visualized. Needle Insertion: Using an in-plane technique, the needle will be advanced to the transverse process. Injection: After confirming the needle position with 1-2 mL saline, 30 mL of 0.25% bupivacaine will be injected between the erector spinae muscle and transverse process, with spread monitored via ultrasound.

PROCEDURE

serratus posterior superior intercostal plane block

In Group 3, SPSIP block will be administered after surgery but before the patient is awakened, under sterile conditions and ultrasound guidance. Patient Positioning: The patient will be placed laterally with the surgical side up, using a sterile ultrasound probe cover. Ultrasound Imaging: A high-frequency (11-12 MHz) linear probe will be positioned sagittally at the scapula's upper corner to visualize the rhomboid major, trapezius, serratus posterior superior muscles, and the third rib. Anatomy Identification: The third rib and serratus posterior superior muscle will be identified. Needle Insertion: Using an in-plane technique, the needle will be advanced between the serratus posterior superior muscle and the third rib. Injection: After confirming the needle position with 1-2 mL saline, 30 mL of 0.25% bupivacaine will be injected into the space, with spread monitored via ultrasound.

DRUG

0.25% bupivacaine

0.25% bupivacaine

Sponsors & Collaborators

• Medipol University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

80 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-01-27

Primary Completion

2025-08-01

Completion

2025-09-01

Countries

• Turkey (Türkiye)

Study Locations