Comparative efficacy of combined serratus anterior plane block and pecto-intercostal fascial plane block versus erector spinae plane block in patients having breast cancer surgery: a randomized study
Abstract
Introduction: Patients who experience discomfort during the first 3 days following surgery are more likely to develop chronic pain, which further reduces their range of motion and quality of life. Various methods and approaches are used to manage postoperative pain. While some are successful in delivering sufficient analgesia, others are unable to manage postoperative pain. This study compared the mean postoperative morphine consumption between erector spinae plane block vs serratus anterior block + pecto-intercostal plane block in major breast cancer surgeries.
Methods: Female patients aged 18 to 45 who were undergoing significant breast cancer procedures. Exclusion criteria included patients with uncontrolled conditions such as asthma, COPD, or other lung diseases, patients with coagulopathies or bleeding problems, and patients with bilateral breast cancer surgeries. Group A got an ultrasound-guided ESPB and Group B received a combined ultrasound-guided SAPB and a pecto-intercostal plane block. Using the NRS, an RN registered nurse evaluated the patient's pain score every four hours and 24 hours postoperatively.
Results: The NRS was used in this study to record pain scores at 4, 8, 12, 16, and 24 hours after surgery. The groups' pain assessments at various intervals showed a statistically significant difference. According to my research, the average amount of morphine used after major breast cancer procedures was 18.60 ± 3.37 mg for erector spinae plane block and 9.10 ± 2.02 mg for serratus anterior block + pecto-intercostal plane block.
Conclusion: We found that the serratus anterior block + pecto-intercostal plane block gives patients who had major breast surgery longer pain relief, less pain, and fewer doses of pain medicine after the surgery than the erector spinae plane block.
Keywords: Breast surgeries; Serratus anterior block; Erector spinae plane block; Pain score; Morphine consumption
Citation: Rehman H, Ashfaq AD, Iqbal A. Comparative efficacy of combined serratus anterior plane block and pecto-intercostal fascial plane block versus erector spinae plane block in patients having breast cancer surgery: a randomized study. Anaesth. pain intensive care. 2026;30(5):628-632. DOI: 10.35975/apic.v30i5.3255
Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2025
