Pain, Postoperative
Conditions
Keywords
Deep Serratus Block, Reconstructive Breast Surgery, Superficial Serratus block
Brief summary
The novel introduction of various chest wall blocks such as the Pecs I and II/modified Pecs blocks as well as the Serratus Anterior Plane Block have extended the application of perioperative regional anesthesia to provide analgesia for breast surgery. However, to our knowledge, there are no large studies that truly delineate the optimal injection site for the Serratus Anterior Plane Block.
Detailed description
Analgesia for reconstructive breast surgery can be a challenging undertaking; these women have often been through painful mastectomy procedures coupled with the mental and physical discomfort of chemotherapy and its attendant side effects. Additionally, the surgery itself can provoke significant pain; often requiring extensive dissection of soft tissue and muscle to provide flap coverage as well the real discomfort of tissue expansion. The literature has described 2 possible injection sites for the Serratus Anterior Block, however, no study has defined optimal location based on analgesia and duration. Patients will be randomized to receive a deep Serratus Anterior Block (DSAB) where local anesthetic is deposited deep to the serratus or a superficial Serratus Anterior Block (SSAB) where the local anesthetic is placed between serratus and latissimus dorsi. The investigator will then evaluate the difference based on pain scores, opiate consumption, length of hospital stay, as well as nausea and vomiting.
Interventions
DRUGBupivacaine
20-60cc of 0.25% Bupivacaine
DRUGDexamethasone
2-4mg of Dexamethasone
Sponsors
University of Alabama at Birmingham
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
There has been no large, randomized study to define optimal location of injection based on analgesia and duration. Patients will be randomized to receive a deep Serratus Anterior Block (DSAB) where local anesthetic is deposited deep to the serratus or a superficial Serratus Anterior Block (SSAB) where the local anesthetic is placed between serratus and latissimus dorsi.
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients undergoing reconstructive breast surgery
Exclusion criteria
* Patients with allergies to the local anesthetic * Patients who do no consent to regional anesthesia * Patients in which serratus block would be contraindicated * Patients whose anatomy preclude placement of the block
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Pain Score | baseline to 48 hrs postoperatively | Collection of pain scores (VAS) until approximately 48 hours post-operatively |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average Opioid consumption | 48 hrs postoperatively | Average opioid consumption 48hrs postoperatively between study group and control |
| Length of Stay | baseline to 72 hrs post-operatively | Number of days in the hospital |
| PONV Medications | baseline to 48 hrs post-operatively | Mean time onset use of rescue PONV medications postoperatively |
Countries
United States
Outcome results
None listed