Research Articles | Challenge Journal of Perioperative Medicine

Deep serratus anterior plane block vs. rhomboid intercostal plane block for analgesia after breast cancer surgery: A prospective, double-blind randomized study

Doğukan Kilit, Zeliha Özer


DOI: https://doi.org/10.20528/cjpm.2025.03.006
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Abstract


Background: Ultrasound-guided interfascial plane blocks are widely used in breast cancer surgery, but direct comparisons of deep serratus anterior plane block (SAPB) and rhomboid intercostal plane block (RIPB) are limited.

Materials and Methods: Single-center, prospective, randomized, double-blind trial of 40 women (ASA I–III) undergoing oncologic breast surgery. Participants were allocated to SAPB or RIPB, both as single-shot, ultrasound-guided adjuncts to standardized multimodal analgesia. The primary outcome was 24-hour morphine consumption; secondary outcomes were pain scores (NRS at rest and with 90° arm abduction at prespecified times), time to first analgesic request, and adverse events.

Results: All randomized patients completed follow-up. Baseline features were comparable except for higher body weight in the SAPB group. The primary outcome did not differ between groups; pain scores were low throughout and showed no between-group differences. Time to first analgesic was similar (log-rank p=0.439). No block-related serious adverse events occurred.

Conclusions: Within a standardized multimodal pathway, SAPB and RIPB provided similar early analgesia with low opioid use and a reassuring safety profile. Although the study was not designed for non-inferiority, the findings support RIPB as a practical alternative to SAPB in routine breast cancer surgery. Larger, procedure-stratified studies‒including quality-of-recovery and longer-term outcomes‒are warranted.


Keywords


deep serratus plane block; rhomboid intercostal plane block; pain; breast surgery

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