The effect of ultrasound guided romboid intercostal and serratus anterior plane block on postoperative respiratory functions and analgesia in patients undertaking radical mastectomy

Objective: The primary hypothesis of the study is that respiratory functions of the patients who will be performed modified radical mastectomy (MRM) and receive rhomboid intercostal plane (RIP) block and serratus anterior plane (SAP) block, will be better at the postoperative second hour than the respiratory functions of the patients who will not receive any block procedures. The secondary hypothesis is that RIP+SAP blocks will provide reduction in the pain scores and opioid consumption in the postoperative first 24 hours. Materials and Method: The patients who were scheduled for MRM under general anesthesia, aged between 18-65 years and ASA scores I-II were included in the study. Respiratory functions (FEV₁, FVC, FEV₁/FVC, PEF, FEF25-75) of the patients were measured by a hand-held spirometry device prior to the operation in the surgical ward. After the induction of anesthesia was provided similarly in all patients, the patients were intubated and randomly divided into two groups. One group received RIP+SAP block using 40 milliliters of %0.25 bupivacaine, no block procedure was performed to other group. The standard analgesia was provided by intraoperative intravenous (iv) infusion of dexketoprofen 50 mg and iv tramadol 1 mg/kg administered 15 minutes before end of the surgery. Respiratory functions of the patients were measured at the postoperative 2nd, 4th and 24th hours, NRS scores were evaluated at the postoperative 15th, 30th minutes and 1st, 2nd, 6th, 12th and 24th hours, opioid consumption was recorded at the postoperative 24th hour. Results: Data of 64 patients, with an average age of 50, were analyzed in the study. The postoperative changes in FVC, PEF and FEF25-75 values were detected to be statistically lower in the study group (RIP+SAP) compared to control group. Opioid consumption at the postoperative 1st, 2nd and 6th hours were found to be significantly lower in the study group. Postoperative NRS scores during resting and movement were found to be significantly lower in the study group. Conclusion: In the current study, we found that RIP+SAP blocks which were performed as a component of analgesia, provided better postoperative FVC, PEF and FEF25-75 values, decreased NRS scored and opioid consumption more than control group following MRM. Key Words: Analgesia, Postoperative Pain, Rhomboid İntercostal Plane Block, Serratus Anterior Plane Block, Respiratory Functions.