RecruitingNot ApplicableNCT07446868

Ultrasound-Guided SPSIP Versus ESPB for Postoperative Pain After Modified Radical Mastectomy

Ultrasound-Guided Serratus Posterior Superior Intercostal Plane Block Versus Erector Spinae Plane Block for Postoperative Pain Management After Modified Radical Mastectomy: A Randomized Clinical Trial

Sponsor

Cairo University

Enrollment

50 participants

Start Date

Mar 1, 2026

Study Type

INTERVENTIONAL

Conditions

Breast Cancer Postoperative Pain Acute Post-surgical Pain

Summary

Breast cancer is the most common cancer affecting women worldwide. Modified radical mastectomy is one of the main surgical treatments for breast cancer. However, this surgery is often associated with significant postoperative pain, which may delay recovery and increase the need for opioid medications such as morphine. Regional anesthesia techniques are increasingly used to improve pain control after breast surgery and reduce opioid consumption. The erector spinae plane block (ESPB) is a well-established ultrasound-guided technique that provides effective chest wall analgesia. The serratus posterior superior intercostal plane (SPSIP) block is a newer ultrasound-guided technique that targets intercostal nerves and may provide effective postoperative pain relief. The purpose of this randomized clinical trial is to compare the effectiveness of SPSIP block versus ESPB block in controlling pain after modified radical mastectomy. The primary outcome will be total morphine consumption during the first 24 hours after surgery. Secondary outcomes include pain scores, time to first request for rescue analgesia, hemodynamic stability, recovery profile, patient satisfaction, and postoperative side effects such as nausea and vomiting. This study aims to determine whether the newer SPSIP block provides comparable or superior pain control to ESPB, with the goal of improving postoperative recovery and reducing opioid requirements in breast cancer patients.

Eligibility

Sex: FEMALEMin Age: 18 YearsMax Age: 65 Years

Inclusion Criteria6

Female patients diagnosed with breast cancer.
Scheduled for Modified Radical Mastectomy (MRM).
American Society of Anesthesiologists (ASA) physical status II or III.
Age between 18 and 65 years.
Body Mass Index (BMI) \> 20 kg/m² and \< 35 kg/m².
Ability to understand the study protocol and provide written informed consent.

Exclusion Criteria9

Patient refusal to participate.
ASA physical status IV or higher.
Age \< 18 years or \> 65 years.
BMI ≤ 20 kg/m² or ≥ 35 kg/m².
Known hypersensitivity or contraindication to local anesthetics, opioids, or study medications.
History of chronic pain or regular opioid use.
History of significant psychiatric disorders affecting pain assessment.
Contraindications to regional anesthesia (e.g., infection at injection site, coagulopathy, pre-existing peripheral neuropathy).
Severe respiratory, cardiac, hepatic, or renal disease.

Interventions

PROCEDURESerratus Posterior Superior Intercostal Plane Block

Ultrasound-guided serratus posterior superior intercostal plane block performed preoperatively. A 22G block needle is advanced in-plane under ultrasound guidance to the fascial plane between the serratus posterior superior muscle and the intercostal muscles at the level of the second or third rib. After negative aspiration, 20 mL of 0.25% bupivacaine is injected. The block is performed 30-45 minutes before surgery.

PROCEDUREErector Spinae Plane Block

Ultrasound-guided erector spinae plane block performed preoperatively. A 22G needle is inserted in-plane to contact the transverse process at the T4-T5 level. After confirmation of correct placement and negative aspiration, 20 mL of 0.25% bupivacaine is injected deep to the erector spinae muscle. The block is performed 30-45 minutes before surgery.