A Comparative Study of Erector Spinae Plane Block and Serratus Posterior Superior Intercostal Plane Block on Postoperative Opioid Consumption Following Breast and Axillary Dissection Surgery

NCT06833697 | Completed

• 1 other identifier: breast ESP vs SPSİP
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Breast surgery is one of the most common surgical procedures worldwide. Pain after surgery is an important issue because it affects recovery and mobility. It can also increase the risk of breathing problems. Although opioids are effective for pain relief, they can cause side effects like nausea, vomiting, and breathing difficulties. These side effects can negatively impact patients and their recovery. Reducing opioid use is important for ensuring patient safety and improving the recovery process. To manage pain after breast surgery, two types of nerve blocks can be used: the erector spinae plane block (ESPB) and the serratus posterior superior intercostal plane block (SPSIP). Both methods are effective for providing pain relief after surgery. However, there are not enough studies comparing which method is better. Purpose of the Study: The main aim of this study is to evaluate the effect of ultrasound-guided ESPB and SPSIP blocks on opioid use after breast surgery. Additionally, we will compare opioid-related side effects (like nausea, vomiting, and breathing problems) and pain levels measured with the NRS (Numeric Rating Scale) between the two groups.

Conditions

Breast Surgery; Erector Spinae Plane Block; Serratus Posterior Superior Intercostal Plane Block

Keywords

Breast surgery; Postoperative pain; Erector spinae plane block; Serratus Posterior Superior Intercostal Plane Block; Opioid consumption; Ultrasound-guided nerve block

Outcome Measures

Primary Outcomes (1)

• tramadol consumption

  Total tramadol consumption (mg) in the first 24 hours after surgery.

  irst 24 hours after the operation

Secondary Outcomes (2)

• NRS (Numerical Rating Scale) pain scores

  first 24 hours after the operation

• opioid-related side effects (such as nausea, vomiting, respiratory depression)

  first 24 hours after the operation

Study Arms (3)

Control group

NO INTERVENTION

Patients will not receive any nerve block

ESPB group

EXPERIMENTAL

Patients will receive an erector spinae plane block.

Procedure: erector spinae plane block; Drug: 0.25% bupivacaine

SPSIP group

EXPERIMENTAL

Patients will receive a serratus posterior superior intercostal plane block

Procedure: serratus posterior superior intercostal plane block; Drug: 0.25% bupivacaine

Interventions

erector spinae plane block PROCEDURE

the ESP block will be administered after surgery but before the patient is awakened, under sterile conditions and ultrasound guidance. Patient Positioning: The patient will be placed in the lateral position with the surgical side up, and a sterile ultrasound probe cover will be used. Ultrasound Imaging: A high-frequency (11-12 MHz) linear probe will be placed transversely at the T5 thoracic vertebra. Anatomy Identification: The erector spinae muscle and transverse processes will be visualized. Needle Insertion: Using an in-plane technique, the needle will be advanced to the transverse process. Injection: After confirming the needle position with 1-2 mL saline, 30 mL of 0.25% bupivacaine will be injected between the erector spinae muscle and transverse process, with spread monitored via ultrasound.

ESPB group

serratus posterior superior intercostal plane block PROCEDURE

In Group 3, SPSIP block will be administered after surgery but before the patient is awakened, under sterile conditions and ultrasound guidance. Patient Positioning: The patient will be placed laterally with the surgical side up, using a sterile ultrasound probe cover. Ultrasound Imaging: A high-frequency (11-12 MHz) linear probe will be positioned sagittally at the scapula's upper corner to visualize the rhomboid major, trapezius, serratus posterior superior muscles, and the third rib. Anatomy Identification: The third rib and serratus posterior superior muscle will be identified. Needle Insertion: Using an in-plane technique, the needle will be advanced between the serratus posterior superior muscle and the third rib. Injection: After confirming the needle position with 1-2 mL saline, 30 mL of 0.25% bupivacaine will be injected into the space, with spread monitored via ultrasound.

SPSIP group

0.25% bupivacaine DRUG

0.25% bupivacaine

ESPB group; SPSIP group

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• aged 18-80 years
• Classified as ASA (American Society of Anesthesiologists) physical status I-III
• Scheduled for breast surgery with axillary lymph node dissection

You may not qualify if:

• Patients with a history of allergies
• allergic to local anesthetics
• pregnant women
• psychiatric or neurological disorders

Sponsors & Collaborators

• Medipol University: lead

Study Sites (1)

Medipol University

Istanbul, Turkey (Türkiye)

Location

Related Publications (3)

• Cortes-Flores AO, Jimenez-Tornero J, Morgan-Villela G, Delgado-Gomez M, Zuloaga-Fernandez Del Valle CJ, Garcia-Renteria J, Rendon-Felix J, Fuentes-Orozco C, Macias-Amezcua MD, Ambriz-Gonzalez G, Alvarez-Villasenor AS, Urias-Valdez D, Chavez-Tostado M, Contreras-Hernandez GI, Gonzalez-Ojeda A. Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: Results of a controlled clinical trial. Eur J Cancer Care (Engl). 2018 Jan;27(1). doi: 10.1111/ecc.12686. Epub 2017 May 4.

  PMID: 28474341 BACKGROUND

• Ciftci B, Ekinci M, Yildiz Y. Erector Spinae Plane Block for a Patient who Underwent Both Bilateral Mastectomy and Right Video-Assisted Thoracic Surgery. Turk J Anaesthesiol Reanim. 2020 Apr;48(2):170-171. doi: 10.5152/TJAR.2019.01205. Epub 2019 Nov 11. No abstract available.

  PMID: 32259153 BACKGROUND

• Ciftci B, Alver S, Ahiskalioglu A, Bilal B, Tulgar S. Serratus posterior superior intercostal plane block for breast surgery: a report of three cases, novel block and new indication. Minerva Anestesiol. 2023 Nov;89(11):1054-1056. doi: 10.23736/S0375-9393.23.17432-3. Epub 2023 Jun 1. No abstract available.

  PMID: 37272274 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Bupivacaine

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: January 13, 2025
• First Posted: February 19, 2025
• Study Start: January 27, 2025
• Primary Completion: August 1, 2025
• Study Completion: September 1, 2025
• Last Updated: September 11, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will share

Locations

TU (1)