The effect of different nerve block strategies on the quality of post‐operative recovery in breast cancer patients: A randomized controlled study

Abstract Objective To compare the effects of three types of ultrasound‐guided nerve blocks on post‐operative recovery quality in patients undergoing modified radical mastectomy for unilateral breast cancer. Methods In this randomized double‐blinded trial ( chictr.org.cn , ChiCTR2200059428), 150 female patients were equally assigned to S group (serratus anterior plane block, SAPB) group, P group (paravertebral block, PVB) or ST group (serratus anterior combined with transverse thoracic muscle plane blocks, SA‐TTMPB). The primary outcome was QoR‐15 at five time points after surgery. Secondary outcomes were pain scores, time of first rescue analgesic and chronic pain incidence at 3 months. Results The QoR‐15 total score of S group at 24 h, 48 h, 72 h and 7 days post‐surgery was significantly lower in groups P and ST, while there was no significant difference between groups P and ST (S vs. P vs. ST, 100.29 ± 6.20 vs. 108.51 ± 7.46 vs. 106.46 ± 6.95; 105.59 ± 6.18 vs. 113.06 ± 7.44 vs. 111.22 ± 6.56; 112.51 ± 6.32 vs. 119.88 ± 6.44 vs. 117.62 ± 6.09; 123.00 ± 5.78 vs. 128.86 ± 5.96 vs. 126.92 ± 5.72, p < 0.05). The dynamic and rest NRS scores at 6 and 12 h post‐surgery were significantly higher in group S than in groups P and ST. Conclusion Serratus anterior plane block combined with transverse thoracic muscle plane block and paravertebral block both have better effects than serratus anterior plane block alone in improving patients' early post‐operative recovery quality, and also have an advantage in improving early post‐operative pain. Clinical Trial Registration chictr.org.cn (ChiCTR2200059428). Date of Registration 29 April 2022. Significance Serratus anterior combined with transverse thoracic muscle plane block may be a safer, easier, and equally effective nerve block strategy than paravertebral block in patients undergoing modified radical mastectomy for unilateral breast cancer.