Is the serratus posterior superior intercostal plane block a viable alternative to the erector spinae plane block for postoperative analgesia in breast surgery - A prospective, randomized trial

Sep 29, 2026

Uploaded by Franzy

Background Effective management of postoperative pain remains challenging after breast surgery. Regional nerve blocks are used to reduce surgical pain, and this trial aimed to evaluate and compare the analgesic efficacy of erector spinae plane block (ESPB) versus serratus posterior superior intercostal plane block (SPSIPB) in breast surgery patients. Methods Fifty women (ASA I–III) undergoing unilateral breast cancer surgery received either ESPB or SPSIPB before general anesthesia, with tramadol-based PCA. Pain was assessed by VAS at predefined times, and outcomes included opioid use, rescue analgesia, PONV, block time, side effects, and satisfaction. Results VAS scores did not differ at rest or on coughing. Tramadol consumption was lower with SPSIPB within 24 hours. Conclusions SPSIPB provides analgesia comparable to ESPB with reduced opioid requirements and differing onset and duration of pain relief.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Background

Clinical context and existing techniques

Arık etal. BMC Anesthesiology (2026) 26:11 [https://doi.org/10.1186/s12871-025-03531-y](https://doi.org/10.1186/s12871-025-03531-y) BMC Anesthesiology RESEARCH Open Access Is the serratus posterior superior intercostal plane block a viable alternative to the erector spinae plane block for postoperative analgesia in breast surgery? A prospective, randomized trial Emine Arık 1*, Musa Zengin 1, Gaye Şeker2, Onur Küçük3, Ezgi Güngördü 1, Yusuf Özgüner 1, Ali Alagöz4 and Jülide Ergil 1 Abstract Background Effective management of postoperative pain remains a significant challenge after breast surgery. Among the available strategies, regional nerve blocks play a key role in alleviating surgical pain in these patients. This study was aimed to evaluate and compare the analgesic efficacy of two regional techniques—erector spinae plane block (ESPB) and serratus posterior superior intercostal plane block (SPSIPB)—in patients undergoing breast surgery. Methods This study included 50 female patients aged 18 to 65 years, classified as ASA physical status I-III, with a body mass index ranging from 18 to 35 kg/m², who were scheduled to undergo unilateral breast cancer surgery. Based on random group allocation, either ESPB or SPSIPB was administered before the induction of general anesthesia. Postoperative analgesia was provided using a tramadol-based patient-controlled analgesia (PCA) system. Pain intensity was assessed with the visual analog scale (VAS) at specific predetermined time points: immediately postoperatively (0 h), and at 1, 4, 8, 12, and 24 h. The primary outcome was postoperative pain intensity assessed using theVAS at predetermined time points. Secondary outcomes included total opioid consumption via PCA, requirement for rescue analgesia, incidence of postoperative nausea/vomiting (PONV), block performance time, side effects, and patient satisfaction. Results There were no significant differences in VAS scores at rest or during coughing between the two groups at any of the assessed postoperative time points (0, 1, 4, 8, 12, and 24 h) (p > 0. 05) . A statistically significant difference in postoperative tramadol consumption was observed between the groups, with the ESPB group receiving 137.6 ± 124 mg and the SPSIPB group receiving 82.4 ± 102 mg via PCA, corresponding to an average reduction of 55.2 mg in the SPSIPB group (p = 0 . 044) . The difference in consumption was due to the difference in consumption between 4 and 8 h. In the ESPB group, the average tramadol consumption during this period was 75.2 mg, while in *Correspondence: Emine Arık[emineincearik@yahoo.com](emineincearik@yahoo.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Arık et al. BMC Anesthesiology (2026) 26:11 Page 2 of 11 the SPSIPB group, it was 36.8 mg (p = 0 . 007) . No significant differences were found between the groups regarding PONV, s

FAQs

What is the main objective of this study?

To compare the analgesic efficacy of SPSIPB versus ESPB for postoperative pain in patients undergoing breast surgery.

How were patients treated and how was pain measured?

Fifty women received either ESPB or SPSIPB before general anesthesia, and postoperative analgesia used tramadol-based PCA. Pain was assessed using VAS at predefined times.

What were the key findings regarding pain scores and opioid use?

VAS scores at rest or during coughing showed no significant differences between groups at measured times. Tramadol consumption was significantly lower with SPSIPB, with differences driven during the 4–8 hour period.

Sep 29, 2026

Uploaded by Franzy