Effect of Different Volumes of SPSIP Block in Breast Surgery

Bursa City Hospital90 enrolled

Overview

This randomized, double-blind study will compare the effectiveness of three different volumes of serratus posterior superior intercostal plane block for postoperative pain control in patients undergoing unilateral breast surgery with axillary lymph node dissection. Ninety participants will be randomly assigned to receive 20 mL, 30 mL, or 40 mL of 0.25% bupivacaine. The primary outcome is total tramadol consumption during the first 24 hours after surgery. Pain scores, time to first analgesic request, rescue analgesic use, quality of recovery, postoperative nausea and vomiting, block success, and block-related complications will also be evaluated.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

DOUBLE

Enrollment

Conditions

Postoperative Pain

Interventions

A single ultrasound-guided serratus posterior superior intercostal plane block will be performed before general anesthesia using 20 mL of 0.25% bupivacaine. The local anesthetic will be injected between the serratus posterior superior and intercostal muscles at the T3-T4 level.

Bupivacaine 0.25% (30 mL)DRUG

A single ultrasound-guided serratus posterior superior intercostal plane block will be performed before general anesthesia using 30 mL of 0.25% bupivacaine. The local anesthetic will be injected between the serratus posterior superior and intercostal muscles at the T3-T4 level.

Bupivacaine 0.25% (40 mL)DRUG

A single ultrasound-guided serratus posterior superior intercostal plane block will be performed before general anesthesia using 40 mL of 0.25% bupivacaine. The local anesthetic will be injected between the serratus posterior superior and intercostal muscles at the T3-T4 level.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged 18 to 75 years * American Society of Anesthesiologists physical status I-III * Scheduled for elective unilateral breast surgery under general anesthesia * Able to provide written informed consent Exclusion Criteria: * Refusal to participate * Coagulopathy * Known allergy to local anesthetics or a history of local anesthetic systemic toxicity * Liver or kidney failure * Uncontrolled diabetes mellitus * Uncontrolled hypertension * Cognitive impairment or inability to understand the study procedures * Chronic pain requiring opioid therapy * Current antidepressant use * Neuropathic pain * Infection at the block injection site * Pregnancy, suspected pregnancy, or breastfeeding * Clinically significant frailty

Outcomes

Primary Outcomes

Total Postoperative Tramadol Consumption

Cumulative tramadol consumption delivered through patient-controlled analgesia will be recorded in milligrams and compared among the 20 mL, 30 mL, and 40 mL SPSIP block groups. Higher values indicate greater opioid consumption.

Time frame: During the first 24 hours after surgery

Secondary Outcomes

Postoperative Pain Intensity

Pain intensity will be assessed using the 11-point Numerical Rating Scale, ranging from 0 (no pain) to 10 (worst imaginable pain). Static pain will be evaluated at rest. Dynamic pain will be evaluated during 30-60 degrees of arm abduction on the operated side and during deep inspiration. Higher scores indicate greater pain intensity.

Time frame: At 0, 2, 4, 8, 16, and 24 hours after surgery

Quality of Recovery-15 Score

Postoperative quality of recovery will be assessed using the Quality of Recovery-15 questionnaire. The total score ranges from 0 to 150, with higher scores indicating better postoperative recovery.

Time frame: At 24 hours after surgery