Effectiveness of ultrasound guided erector spinae plane block compared to serratus anterior block in modified radical mastectomy: a randomized comparative trial

Background & objectives: Acute postoperative pain occurs in approximately 40-60% of patients undergoing breast surgeries. Multiple thoracic wall blocks have been developed to reduce complications associated with thoracic epidural and paravertebral block including erector spinae plane block (ESPB) and serratus anterior plane block (SAPB). We evaluated and compared ESPB versus SAPB, regarding safety and efficacy to relieve acute postoperative pain in patients undergoing modified radical mastectomy (MRM) under general anesthesia (GA). Method0ology: We recruited 60 female patients, ASA II - III, undergoing MRM under GA, and assigned them into one of the two equal groups: group 1 (SAPB group) and group 2 (ESPB group). The primary outcome was postoperative morphine consumed in the first 24 hours. Secondary outcomes included intraoperative fentanyl consumption, numeric pain rating scale (NRS) scores at rest and movement, post-operative nausea, vomiting and overall patient satisfaction. Results: There was a significantly reduced consumption in postoperative morphine in ESPB group compared to SAPB group (1.70 ± 1.88 vs 4.50 ± 3.03 mg). Intraoperative fentanyl consumption was significantly lower in ESPB group compared to SAPB group (130.6 ± 44.41 vs 160.0 µg ± 53.18; P = 0.031). ESPB group showed significantly lower scores of NRS scores at rest as well as on movement. Conclusion: Erector spinae plane block provides more effective intraoperative as well as postoperative analgesia compared to serratus anterior plane block in patients undergoing modified radical mastectomy under general anesthesia. Key words: Modified Radical Mastectomy; Regional Anesthesia; Nerve Block; Breast Cancer Citation: Magdy M, Zaghloul A, Hamimy WI, Shaban A, Elshamy FH. Effectiveness of ultrasound guided erector spinae plane block compared to serratus anterior block in modified radical mastectomy: a randomized comparative trial. Anaesth. pain intensive care 2025;29(3):430-435. DOI: 10.35975/apic.v29i3.2749 Received: February 16, 2025; Revised: March 17, 2025; Accepted: January 01, 2025