Ultrasound-guided serratus plane block enhances pain relief and quality of recovery after breast cancer surgery

BACKGROUND Multimodal analgesia can improve postoperative pain and possibly accelerate functional recovery after surgery. Serratus plane block (SPB) is a novel, ultrasound-guided regional anaesthetic technique for complete analgesia of the anterolateral chest wall. But, the effect of SPB on the quality of recovery after breast cancer surgery has not been established. OBJECTIVE To test the hypothesis that pre-operative SPB would enhance the quality of recovery following breast cancer surgery. DESIGN A randomised, double-blind, parallel-group, placebo-controlled trial. SETTING Single university teaching hospital, from March 2016 to June 2017. PATIENTS Seventy-two women scheduled for breast cancer surgery. INTERVENTION Participants were randomised in a 1 : 1 ratio to receive SPB with 25 ml of ropivacaine 0.5% or physiological saline. MAIN OUTCOME MEASURES The primary endpoint was the 40-item Quality of Recovery questionnaire score 24 hours postoperatively hours. Secondary endpoints were postoperative pain intensity, cumulative opioid consumption, postoperative nausea and vomiting, dizziness, post anaesthesia care unit discharge time and patient satisfaction. RESULTS The global median [IQR] 40-item Quality of Recovery questionnaire score at 24 postoperative hours was significantly higher in the SPB group (158 [153.8 to 159.3]) than the control group (141 [139 to 145.3]) with a median difference of 15 (95% confidence interval: 13 to 17, P < 0.001). Compared with the control group, postoperative pain scores at rest were significantly lower up to 24 h in the SPB group. Pre-operative SPB reduced postoperative cumulative opioid consumption, the incidence of postoperative nausea and vomiting and the post anaesthesia care unit discharge time. In addition, patient satisfaction scores were higher in the SPB group. CONCLUSION Pre-operative administration of SPB with ropivacaine improved the quality of recovery, postoperative analgesia and patient satisfaction following breast cancer surgery. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT02691195).