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Turkish Journal of Medical Sciences

Abstract

Background/aim: This noninferiority trial aimed to evaluate whether the serratus posterior superior intercostal plane block (SPSIPB) provides noninferior postoperative analgesia compared with the thoracic paravertebral block (TPVB) after unilateral mastectomy.

Materials and methods: This prospective, randomized, assessor-blinded, parallel-group noninferiority trial enrolled 60 female patients scheduled for elective unilateral mastectomy. Patients received either ultrasound-guided SPSIPB (n = 30) or TPVB (n = 30) with 30 mL of 0.25% bupivacaine before induction. The primary outcome was visual analogue scale (VAS) pain scores (0–100 mm) at rest and during coughing over 24 h. Noninferiority was assessed using the Hodges–Lehmann median difference with 95% confidence intervals (CIs) and a prespecified margin of 13 mm, corresponding to the validated minimal clinically important difference (MCID). Secondary outcomes included opioid consumption, area under the curve (AUC) for cumulative pain burden, and patient satisfaction.

Results: All 60 patients completed the study. At the first postoperative hour, TPVB provided lower VAS scores at rest (median 10.0 vs. 23.0 mm, 95% CI of difference: 0 to 19). For resting VAS, noninferiority was demonstrated at 0 h, 4 h, and 24 h (upper bounds: 11.5 mm, 12.5 mm, and 5.0 mm). The 24-h AUC for resting VAS was comparable between groups (426 mm/h vs. 426.5 mm/h, p = 0.652). SPSIPB produced significantly lower tramadol consumption in the 12-to-24-h interval (median 0 vs. 50 mg, p < 0.001). However, total opioid consumption over the 24 h was comparable (p = 0.070). No block-related complications occurred in either group.

Conclusion: Noninferiority of SPSIPB to TPVB was demonstrated for resting pain scores at the majority of postoperative time points after unilateral mastectomy. TPVB provided a transient early-phase analgesic advantage at 1 h and 2 h, while SPSIPB was associated with late-phase opioid sparing. The comparable cumulative pain burden across 24 h suggests that SPSIPB may serve as a periparavertebral alternative to TPVB when sustained analgesia and opioid reduction are clinical priorities.

Author ORCID Identifier

MUSTAFA SIRRI KOTANOĞLU: 0000-0002-6906-573X

MUSA ZENGİN: 0000-0003-2249-6521

ONUR KÜÇÜK: 0000-0001-5534-7579

ATAKAN SEZGİ: 0000-0003-4566-3521

İBRAHİM TOPCU: 0009-0001-5865-5144

ARAS METİN: 0000-0002-2893-269X

ZEYNEP ERSOY: 0000-0003-0767-1088

JÜLİDE ERGİL: 0000-0002-4580-7866

DOI

10.55730/1300-0144.6201

Keywords

breast surgery, noninferiority trial, postoperative analgesia, regional anesthesia, Serratus posterior superior intercostal plane block, thoracic paravertebral block

First Page

674

Last Page

686

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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