Serratus anterior plane versus paravertebral nerve blocks for postoperative analgesia after non-mastectomy breast surgery: a randomized controlled non-inferiority trial.

Autor:	Gabriel RA; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA ragabriel@health.ucsd.edu.; Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA., Swisher MW; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA., Sztain JF; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA., Curran BP; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA., Said ET; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA., Abramson WB; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA., Khatibi B; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA., Alexander BS; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA., Finneran JJ; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA., Wallace AM; Department of Surgery, University of California San Diego, La Jolla, California, USA., Armani A; Department of Surgery, University of California San Diego, La Jolla, California, USA., Blair S; Department of Surgery, University of California San Diego, La Jolla, California, USA., Dobke M; Department of Surgery, University of California San Diego, La Jolla, California, USA., Suliman A; Department of Surgery, University of California San Diego, La Jolla, California, USA., Reid C; Department of Surgery, University of California San Diego, La Jolla, California, USA., Donohue MC; Department of Neurology, University of Southern California, Los Angeles, California, USA., Ilfeld BM; Department of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2021 Sep; Vol. 46 (9), pp. 773-778. Date of Electronic Publication: 2021 Jun 22.
DOI:	10.1136/rapm-2021-102785
Abstrakt:	Background: Paravertebral and serratus plane blocks are both used to treat pain following breast surgery. However, it remains unknown if the newer serratus block provides comparable analgesia to the decades-old paravertebral technique. Methods: Subjects undergoing unilateral or bilateral non-mastectomy breast surgery were randomized to a single-injection serratus or paravertebral block in a subject-masked fashion (ropivacaine 0.5%; 20 mL unilateral; 16 mL/side bilateral). We hypothesized that (1) analgesia would be non-inferior in the recovery room with serratus blocks (measurement: Numeric Rating Scale), and (2) opioid consumption would be non-inferior with serratus blocks in the operating and recovery rooms. In order to claim that serratus blocks are non-inferior to paravertebral blocks, both hypotheses must be at least non-inferior. Results: Within the recovery room, pain scores for participants with serratus blocks (n=49) had a median (IQR) of 4.0 (0-5.5) vs 0 (0-3.0) for those with paravertebral blocks (n=51): 0.95% CI -3.00 to -0.00; p=0.001. However, the difference in morphine equivalents did not reach statistical significance for superiority with the serratus group consuming 14 mg (10-19) vs 10 mg (10-16) for the paravertebral group: 95% CI -4.50 to 0.00, p=0.123. Since the 95% CI lower limit of -4.5 was less than our prespecified margin of -2.0, we failed to conclude non-inferiority of the serratus block with regard to opioid consumption. Conclusions: Serratus blocks provided inferior analgesia compared with paravertebral blocks. Without a dramatic improvement in safety profile for serratus blocks, it appears that paravertebral blocks are superior to serratus blocks for postoperative analgesia after non-mastectomy breast surgery. Trial Registration Number: NCT03860974. Competing Interests: Competing interests: The University of California has received funding and product for other research projects from Epimed International (Farmers Branch, Texas, USA); Infutronics (Natick, Massachusetts, USA); and SPR Therapeutics (Cleveland, Ohio, USA) for the following authors: RG, MWS, JFS, ETS, BK, JJF, AMW and BMI. RG is a consultant for Avanos (Alpharetta, Georgia, USA). (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu