• Jason T Edwards, Xuan T Langridge, Gloria S Cheng, Mandy M McBroom, Abu Minhajuddin, and Anthony T Machi.
• Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
• J Clin Anesth. 2021 Dec 1; 75: 110470.

Study ObjectiveIn the initial description of the serratus anterior plane block (SAPB), both superficial and deep SAPB provided effective blockade. The purpose of this study was to investigate the difference in opioid consumption and postoperative analgesia between superficial and deep SAPB for patients undergoing mastectomy.DesignRandomized prospective trial.SettingAcademic hospital.Patients64 women, >18 years of age, ASA I-III, undergoing single or bilateral mastectomy, with and without lymph node biopsy, with and without tissue expander reconstruction.InterventionEither superficial or deep SAPB by an ultrasound-guided technique in addition to multimodal analgesia.MeasurementsThe primary outcome was opioid consumption in the first 24 h. Secondary outcomes were pain scores, satisfaction scores, incidence of PONV, length of stay and block performance time.ResultsSubjects who received a deep SAPB required 30% less oral morphine equivalents (OME) (113.5 mg vs. 147 mg, p = 0.009) and reported lower pain scores. There were no significant differences in satisfaction scores, incidence of PONV, LOS, or block performance time between the two groups.ConclusionThere was a significant difference in opioid consumption between the deep and superficial SAPB groups. Subjects in the deep SAPB group had lower pain scores at 12 h; however, the difference was not statistically significant at other time points. While both the superficial and the deep SAPB can be used for post-operative analgesia in patients undergoing mastectomy, our study suggests that the deep SAPB may improve analgesia to a greater degree than the superficial SAPB as shown through decreased opioid consumption of 30% over a 24-h period post-block. CLINICAL TRIAL NUMBER AND REGISTRY URL: clinicaltrials.gov: NCT03154658.Copyright © 2021 Elsevier Inc. All rights reserved.

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