1. Introduction
Breast cancer is one of the most common malignant tumors in women
[1]. Postoperative pain is a significant concern following
modified radical mastectomy (MRM)
[2]. Excision of the pectoralis major fascia and extension of the
pectoralis muscles to improve surgical access are likely causes of
perioperative myofascial pain [3]. Moreover, drain placement may
contribute to pain experienced during the postoperative period. In
addition to branches of the intercostal nerves, the pectoral,
thoracodorsal and long thoracic nerves may also be involved in
perioperative pain following radical mastectomy with axillary
involvement [2]. Therefore, many different kinds of analgesic
techniques have been proposed, including intercostal block, local
anesthetic infiltration, erector spinae plane block (ESP), paravertebral
block, serratus plane block (SAB block) and rhomboid intercostal block
(RIB) block to relieve acute postoperative pain [3-7]. it is still
not clear which one is superior to others. The effects of regional block
technology needs to be compared by
further researches.
Ultrasound-guided erector spinae plane (US-ESP) block is a fascial nerve
block technique described for the first time by Forero et al [8].
US-ESP can provide effective postoperative analgesia for patients
undergoing modified radical mastectomy [3]. Serratus plane block
(SAB) is a new analgesic technique proposed by Blanco et al [9], and
provides a good postoperative analgesic effect in patients undergoing
MRM [7, 10]. Ultrasound-guided rhomboid intercostal block (US-RIB)
is a new fascial block technique discovered by Elsharkawy et al.[11]
in 2016. Recently, some clinical studies have reported that RIB can
effectively reduce postoperative pain in patients with breast cancer
after MRM. However, the comparison of postoperative analgesic effects of
RIB, SAB and ESP block on patients undergoing MRM has not been reported.
In the current research, we compared the analgesic effects of these
three kinds of nerve block after MRM for the first time.
This prospective randomized controlled trial was performed to analyze
the postoperative analgesic efects of ultrasound-guided RIB, ESP and SAB
block after MRM. The primary hypothesis of this study is that the
ultrasound-guided RIB block and ESP block reduced postoperative tramadol
consumption and pain scores more efectively than the SAB block in the
frst 24 h after MRM.