الفهرس 
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Abstract
Modified radical mastectomy (MRM) is one of the most common
surgeries performed, and one that may be associated with significant acute
postoperative pain in breast surgery. Acute postoperative pain is an
independent risk factor in the development of chronic post-mastectomy
pain.
Various regional anesthetic procedures have been tried to provide
better acute pain control and, consequently, less chronic pain. They can
reduce perioperative opiates requirement and thereby decreasing their
possible side effects. These regional procedures include local wound
infiltration, lumbar intrathecal fentanyl injection, thoracic epidural,
thoracic PVB, and ultrasound (US)-guided interfascial plane blocks.
Currently, Ultrasound (US)-guided interfascial plane blocks have
been recommended as safe, easy, and reliable alternatives to the use of
thoracic epidural analgesia and paravertebral block in providing analgesia
for patients about to undergo breast surgery.
Serratus anterior plane block (SAPB) is one of the Ultrasound (US)-
guided interfascial plane blocks, it blocks the intercostal nerves II–VI by
injection above or below the serratus muscle in the mid-axillary line and
spares the pectoral nerves.
We assumed that SAPB could safely provide a better analgesic
profile with an opioid-sparing effect than Intrathecal fentanyl.
Therefore, the aim of this work was to compare the analgesic effect,
IV analgesics consumption, hemodynamics and intraoperative and
postoperative complications between SAPB and lumbar intrathecal
fentanyl injection among patients scheduled for MRM.
This prospective randomized study conducted on 50 patients with ASA
grade I to II scheduled for Modified Radical Mastectomy surgery. Patients
were randomly categorized into two equal groups; group A: received
SAPB 30 ml bupivacaine 0.25%. group B: received 25 microgram
intracthecal fentanyl immediately preoperative.Summary
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Summary of our results:
VAS was significantly higher in group B than group A at 1h, 2h, 3h,
4h, 5h, 6h, 9h and 18h (P value <0.05) and insignificantly different
at 12h, 15h,21h and 24h between both groups.
Time of rescue analgesia was significantly earlier in group B than
group A (P <0.001).
Dose of morphine and Ketorolac were significantly higher in Group
B than group A (P <0.001).
Intraoperative heart rate and MAP were insignificantly different
between both groups at all times of measurements.
Postoperative heart rate was significantly higher in group B than
group A after1h, 2h, 3h, 6h and 12h (P value <0.001) and
insignificantly different at 30 min and 24 h between both groups.
Postoperative MAP was significantly higher in group B than group
A at 1h, 2h, 3h, 6h and 12h (P value <0.001).
Intraoperative and postoperative SpO2 were insignificantly different
between both groups at all times of measurements.
Conclusion
In cases undergoing modified radical mastectomy, the ultrasound guided
SAP block (with 30ml bupivacaine 0.25%) affords adequate analgesia through
providing stable hemodynamics postoperatively and lower pain in addition to
delayed time to first rescue analgesia with low doses of morphine and ketorolac
when compared to lumbar intrathecal fentanyl injection (with 25 microgram
fentanyl).
Limitations
It was a single center study, and the results may differ elsewhere.
A single injection was used for the groups however, a catheter insertion for
continuous analgesia can be used instead to extend the duration of
analgesia and further reduce postoperative morphine consumption.
The sample size was relatively small to generalize the results.
Short follow up period.
Recommendations
The ultrasound guided SAPB is efficient to provide effective analgesia in
patients undergoing modified radical mastectomy.
Future research for assessing the effectiveness of ultrasound guided SAPB
in other surgeries are required.
More prospective multicentric studies with larger sample size are
suggested to validate our results.
More studies using different additives, types, and concentrations of LA are
recommended.