Serratus Anterior Plane Block and Costotransverse Block for Analgesia Following Modified Radical Mastectomy Surgeries
NCT ID: NCT06260397
Last Updated: 2024-12-11
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
90 participants
INTERVENTIONAL
2023-12-28
2025-03-30
Brief Summary
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Detailed Description
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Group (A) (SAPB):
SAPB will be performed using an ultrasound machine with a high-frequency linear probe . All patients will be in lateral position to perform the block. At the level of the fourth rib with 45-degree angle, targeting the plane between the latissimus dorsi and serratus muscles, SAPB block will be performed unilaterally on the ipsilateral side of surgery.
Group (B) (CTB):
CTB will be performed using an ultrasound machine with a high-frequency linear probe. All patients will be in lateral position to perform the block. CTB block will be performed unilaterally on the ipsilateral side of surgery at the level of fourth rib.
Group (C) (patient controlled analgesia):
After successful extubation, patients will be transferred to PACU. Patients will receive a bolus dose of 5 mg nalbuphine then PCA pump in the form of 20 mg nalbuphine HCL in 100 ml 0.9% normal saline with basal rate of infusion 5ml/hr with self-administration bolus of 0.5ml with 15 min lock-out time.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
DOUBLE
Study Groups
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serratus anterior plane block
while the patients in lateral position, serratus anterior plane block will be done using high frequency linear ultrasound probe at the level of fourth rib.30 ml of 0.25% bupivacaine will be injected.
serratus anterior plane block
using ultrasound, 30 ml of bupivacaine 0.25% will be injected in the plane between the latissimus dorsi and serratus muscles
costotransverse plane block
while the patients in lateral position, costotransverse block will be done using 22-gauge echogenic needle. the needle is advanced in-plane lateral to the spinous process of the 4th thoracic vertebra from caudally cephalad.30 ml of 0.25% bupivacaine will be injected
costotransverse block
using ultrasound, 30 ml of bupivacaine 0.25% will be injected in the costotransverse plane of fourth rib
patient controlled analgesia
After successful extubation, patients will be transferred to PACU. Patients will receive a bolus dose of 5 mg nalbuphine then PCA pump in the form of 20 mg nalbuphine HCL in 100 ml 0.9% normal saline with basal rate of infusion 5ml/hr with self-administration bolus of 0.5ml with 15 min lock-out time.
patient controlled analgesia
PCA pump in the form of 20 mg nalbuphine HCL in 100 ml 0.9% normal saline with basal rate of infusion 5ml/hr. with self-administration bolus of 0.5ml with 15 min lock-out time.
Interventions
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serratus anterior plane block
using ultrasound, 30 ml of bupivacaine 0.25% will be injected in the plane between the latissimus dorsi and serratus muscles
costotransverse block
using ultrasound, 30 ml of bupivacaine 0.25% will be injected in the costotransverse plane of fourth rib
patient controlled analgesia
PCA pump in the form of 20 mg nalbuphine HCL in 100 ml 0.9% normal saline with basal rate of infusion 5ml/hr. with self-administration bolus of 0.5ml with 15 min lock-out time.
Eligibility Criteria
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Inclusion Criteria
2. Scheduled for modified radical mastectomy (MRM).
3. Body weight ranging from 60 to 100 kilograms.
Exclusion Criteria
2. History of allergy to the medications used in the study.
3. Contraindications to regional anesthesia (including patient: refusal, coagulopathy, and local infection).
4. Psychiatric disorders.
5. Significant cognitive dysfunction.
6. American Society of Anesthesiologists (ASA) Physical Status Class III and IV.
7. Daily use of opioids.
8. Obesity (BMI \> 35 kg/m2).
18 Years
60 Years
FEMALE
Yes
Sponsors
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Ain Shams University
OTHER
Responsible Party
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Locations
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AinShamsU
Cairo, Abbasia, Egypt
Countries
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Central Contacts
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Facility Contacts
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Fatma So Elsayed, MD
Role: primary
References
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Zhao Y, Jin W, Pan P, Feng S, Fu D, Yao J. Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modified radical mastectomy: a comparison with the thoracic paravertebral nerve block. Perioper Med (Lond). 2022 Jul 27;11(1):39. doi: 10.1186/s13741-022-00270-3.
Aygun H, Kiziloglu I, Ozturk NK, Ocal H, Inal A, Kutlucan L, Gonullu E, Tulgar S. Use of ultrasound guided single shot costotransverse block (intertransverse process) in breast cancer surgery: a prospective, randomized, assessor blinded, controlled clinical trial. BMC Anesthesiol. 2022 Apr 18;22(1):110. doi: 10.1186/s12871-022-01651-3.
Holm UHU, Andersen CHS, Hansen CK, Tanggaard K, Borglum J, Nielsen MV. Ultrasound-guided multiple-injection costotransverse block for mastectomy and primary reconstructive surgery. A study protocol. Acta Anaesthesiol Scand. 2022 Mar;66(3):386-391. doi: 10.1111/aas.14018. Epub 2022 Jan 5.
Jack JM, McLellan E, Versyck B, Englesakis MF, Chin KJ. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review. Anaesthesia. 2020 Oct;75(10):1372-1385. doi: 10.1111/anae.15000. Epub 2020 Feb 16.
Sahin A, Baran O, Gultekin A, Yildirim I, Arar C, Gunkaya M. Serratus anterior plane block for tertiary revision rhinoplasty with rib cartilage harvest. J Clin Anesth. 2021 Oct;73:110292. doi: 10.1016/j.jclinane.2021.110292. Epub 2021 Apr 29. No abstract available.
Ohgoshi Y, Usui Y, Ando A, Takeda Y, Ohtsuka A. Injection at the costotransverse notch facilitates paravertebral spread of the erector spinae plane block: A cadaveric study. J Clin Anesth. 2020 May;61:109630. doi: 10.1016/j.jclinane.2019.109630. Epub 2019 Oct 23. No abstract available.
Wang Y, Shi M, Huang S, He X, Gu X, Ma Z. Ultrasound-guided serratus anterior plane block versus paravertebral block on postoperation analgesia and safety following the video-assisted thoracic surgery: A prospective, randomized, double-blinded non-inferiority clinical trial. Asian J Surg. 2023 Oct;46(10):4215-4221. doi: 10.1016/j.asjsur.2022.11.125. Epub 2022 Dec 12.
Other Identifiers
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analgesia for MRM surgeries
Identifier Type: -
Identifier Source: org_study_id