Superficial vs Deep Serratus Anterior Plane Block for Analgesia After Mammoplasty

Mammoplasty surgery is frequently associated with moderate to severe postoperative pain. Inadequate postoperative pain control may negatively affect patient recovery, delay mobilization, and increase opioid consumption. Traditionally, opioids have been widely used for the management of postoperative pain; however, opioid-related adverse effects and the growing concerns regarding opioid misuse have encouraged the use of multimodal analgesia strategies. Regional anesthesia techniques have therefore become an essential component of postoperative pain management and Enhanced Recovery After Surgery (ERAS) protocols.

Peripheral nerve blocks provide effective analgesia, reduce opioid consumption, and improve patient comfort during the postoperative period. In recent years, ultrasound-guided fascial plane blocks have gained increasing popularity due to their relative simplicity, safety, and favorable balance between sensory and motor blockade.

The serratus anterior plane block (SAPB), first described by Rafael Blanco in 2013, is an ultrasound-guided regional anesthesia technique used for analgesia in thoracic and breast surgeries. In this technique, local anesthetic is injected either into the superficial plane between the latissimus dorsi and serratus anterior muscles or into the deep plane between the serratus anterior muscle and the ribs at the mid-axillary line. This block targets the lateral cutaneous branches of the intercostal nerves and provides analgesia to the anterolateral thoracic wall.

Although SAPB has been increasingly used in breast surgeries, there is limited evidence comparing the analgesic efficacy of superficial and deep SAPB techniques in mammoplasty procedures. Therefore, further studies are needed to determine which technique provides superior postoperative analgesia and reduces opioid consumption more effectively.

This prospective, comparative, single-blind clinical study aims to compare the postoperative analgesic effectiveness of superficial and deep serratus anterior plane block techniques in patients undergoing mammoplasty surgery. Adult female patients aged 18-75 years with ASA physical status I-III scheduled for elective mammoplasty surgery will be included in the study. After ultrasound-guided SAPB administration, postoperative opioid consumption within the first 24 hours,pain scores,additional analgesic requirements, vital parameters, ,postoperative nausea and vomiting, patient satisfaction scores, Quality of postoperative recovery assessed using the Quality of Recovery-15 (QoR-15) questionnaire,time to first mobilization, and the length of hospital stay will be recorded and analyzed.

The results of this study are expected to contribute to the optimization of postoperative pain management strategies in mammoplasty surgery by identifying the more effective SAPB technique for reducing postoperative pain and opioid consumption.

Inclusion criteria

• Female patients aged 18-75 years
• ASA physical status I-III
• Patients scheduled for elective mammoplasty surgery (unilateral or bilateral)
• Patients who voluntarily agree to participate in the study and provide informed consent

Exclusion criteria

• ASA physical status IV or higher
• Patients who refuse to participate in the study
• Patients who cannot provide informed consent due to language barriers
• Pregnant patients
• Active infection at the block application site
• Previous surgery affecting the anatomical integrity of the block area
• Known allergy to local anesthetic agents
• Patients with chronic pain or regular analgesic use
• Patients with coagulation disorders
• Patients with neurological or psychiatric disorders affecting pain perception or those using regular antipsychotic or antidepressant medications
• Body mass index (BMI) > 40 kg/m²