Serratus Anterior Muscle Plane Block vsThoracic Paravertebral Block For Unilateral Mastectomies
Breast Cancer, Mastectomy, Regional Anesthesia
About this trial
This is an interventional treatment trial for Breast Cancer
Eligibility Criteria
Inclusion Criteria:
- Simple or radical unilateral mastectomy with or without axillary lymph node dissection.
- American Society of Anesthesia (ASA) I, II and III
Exclusion Criteria:
- Morbid obesity (body mass index > 40 kg/m2);
- Renal insufficiency (creatinine > 2.0 mg/DL),
- Current chronic analgesic therapy (daily use > 4 weeks),
- History of opioid dependence, pregnancy.
- Allergy to local anesthetic
- Rash/infection at the area of injection
- Coagulation disorder
- Patients on anticoagulation
Sites / Locations
- The University of Texas Health Science Center at Houston
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Serratus Anterior Muscle Plane Block
Thoracic Paravertebral Block
The US probe will be placed in the mid-axillary line at the level of the 5th intercostal space. The latissimus dorsi, teres major and serratus muscles will be identified. Using in-plane approach, the block needle (22 G, 50 mm) will be inserted until the tip is visualized between the serratus anterior muscle and the intercostal muscles. As an extra reference point thoracodorsal artery will be used which aids in the identification of the plane superficial to the serratus muscle. After negative aspiration of blood, local anesthetic (20 ml of 0.25 % bupivacaine) will be injected and visualized in real-time.
The spinous processes of T1- T5 will be identified and at parasagittal plan at 2.5 cm, skin wheel will be raised using 1% lidocaine. A 20-gauge, bevel needle will be advanced until the transverse process is located. The depth from skin to transverse process will be marked/identified by needle marking. The needle will be withdrawn 1-2 cm and angled down.The needle will be re-advanced 1cm past the initial marking. After negative aspiration, 4-5 ml of 0.25% bupivacaine will be slowly injected. The same procedure will be repeated at each level from T2 to T6 ensuring total dose of bupivacaine does not exceed the maximum dose recommended.