Postoperative Analgesia in Breast Reduction Surgery, Postoperative Pain, Postoperative Pain Breast Reduction, Pain, Postoperative
Conditions
Brief summary
This prospective, randomized clinical study aims to compare the analgesic efficacy of serratus plane block (SPB) and rhomboid intercostal plane block (RIPB) for postoperative analgesia in patients undergoing elective bilateral breast reduction surgery under general anesthesia. All patients will receive standardized general anesthesia. Before induction of anesthesia, while patients are awake, Group SPB will receive an ultrasound-guided serratus anterior plane block and Group RIPB will receive an ultrasound-guided rhomboid intercostal plane block. Postoperative analgesia will be maintained with intravenous patient-controlled analgesia (PCA) with opioids. Primary outcomes include postoperative pain scores and opioid consumption at 1, 6, 12, and 24 hours. Secondary outcomes include time to first analgesic demand, patient satisfaction, and block-related complications.
Detailed description
Postoperative pain management in breast reduction surgery is challenging due to wide tissue dissection and thoracic wall involvement. Serratus plane block (SPB) and rhomboid intercostal plane block (RIPB) are regional anesthesia techniques that provide analgesia by blocking the lateral cutaneous branches of the intercostal nerves. This randomized controlled trial will compare the analgesic efficacy of SPB and RIPB in female patients aged 18-65 undergoing elective bilateral breast reduction surgery under general anesthesia. Before induction of general anesthesia, while patients are awake, ultrasound-guided SPB or RIPB will be performed according to group allocation. After block performance, general anesthesia will be induced using a standardized protocol. Postoperative pain management will be provided with intravenous patient-controlled analgesia (PCA) with opioids. Primary outcomes include postoperative pain scores (NRS) and opioid consumption. Secondary outcomes include duration of analgesia, time to first analgesic request, patient satisfaction, and block-related complications. The hypothesis is that both blocks will reduce postoperative pain and opioid consumption, but the duration and quality of analgesia may differ between SPB and RIPB.
Interventions
PROCEDURESerratus Anterior Plane Block (SAPB)
"Ultrasound-guided serratus anterior plane block performed preoperatively while patients are awake. A total of 30 mL of local anesthetic solution (5 mL saline, 5 mL of 2% lidocaine, 20 mL of 0.25% bupivacaine) will be used. The total volume will be divided equally between both breasts (15 mL per side), with one injection point on each side at the midaxillary line
PROCEDURERhomboid Intercostal Plane Block (RIPB)
Ultrasound-guided rhomboid intercostal plane block (RIPB) performed preoperatively while patients are awake, using a total of 30 mL local anesthetic solution (5 mL normal saline, 5 mL of 2% lidocaine, and 20 mL of 0.25% bupivacaine). The total volume will be divided equally between both breasts (15 mL per side), with one injection point on each side between the rhomboid major muscle and the intercostal muscles at the medial border of the scapula around the 5th intercostal level.
OTHERNo Regional Block (Control)
Participants in this group will not receive any regional block. Standard general anesthesia and multimodal postoperative analgesia will be provided according to institutional protocol.
Sponsors
Konul Karaja
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
The patients and the outcome assessor who recorded postoperative pain scores were blinded to the type of block performed
Intervention model description
The study includes three parallel groups. Patients undergoing breast reduction surgery are randomly assigned to receive ultrasound-guided serratus anterior plane block (SAPB), ultrasound-guided rhomboid intercostal plane block (RIPB), or no regional block for postoperative analgesia.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Female patients aged 18-65 years American Society of Anesthesiologists (ASA) physical status I-II Scheduled for elective bilateral breast reduction surgery under general anesthesia Willing and able to provide written informed consent
Exclusion criteria
* Allergy or contraindication to local anesthetics (bupivacaine) Coagulopathy or anticoagulant medication use Infection at or near the injection site History of chronic opioid use or psychiatric/neurological disorders affecting pain perception Body mass index (BMI) \> 35 kg/m² Refusal to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Tramadol Consumption Within the First 24 Hours After Surgery | 24 hours after surgery | Total opioid consumption will be recorded using intravenous patient-controlled analgesia (PCA) during the first 24 hours after surgery. The cumulative tramadol dose (mg) administered via PCA will be calculated based on the number of patient-controlled bolus doses. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Scores (NRS) at Rest and During Movement at 1, 6, 12, and 24 Hours | 1, 6, 12, and 24 hours after surgery | Pain intensity will be assessed using the Numeric Rating Scale (NRS), a 0-10 point scale where 0 indicates no pain and 10 indicates the worst imaginable pain. Pain scores will be recorded at rest and during movement at 1, 6, 12, and 24 hours after surgery |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORKonul karaja, MD
Aydın Adnan Menderes University Hospita
Outcome results
None listed