Evidence map›Paper›PMID 34158376›Full record

Trial reportRegional anesthesia and pain medicine2021

Serratus anterior plane versus paravertebral nerve blocks for postoperative analgesia after non-mastectomy breast surgery: a randomized controlled non-inferiority trial.

Rodney A Gabriel, Matthew W Swisher, Jacklynn F Sztain, Brian P Curran, Engy T Said, Wendy B Abramson, Bahareh Khatibi, Brenton S Alexander, John J Finneran, Anne M Wallace and 7 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled TrialEquivalence Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Regional anesthesia and pain medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03860974 (A Randomized, Subject-Masked, Active-Controlled, Parallel-Arm Clinical Trial Comparing Serratus Plane and Paravertebral Nerve Blocks), which is not on this map. Cited by 14 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 3 pooled it
2.9field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03860974 phase4completednot on this map

A Randomized, Subject-Masked, Active-Controlled, Parallel-Arm Clinical Trial Comparing Serratus Plane and Paravertebral Nerve Blocks

TypeinterventionalSponsorUniversity of California, San DiegoRan2019 to 2021Enrolled100ConditionsBreast SurgeryArmsSerratus Plane block (single injection), Paravertebral block (single injection)
3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 3 syntheses or guidelines pooled it, 23 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 2 institutions in 1 country.

Rodney A GabrielDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA ragabriel@health.ucsd.edu.
Matthew W SwisherDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.
Jacklynn F SztainDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.
Brian P CurranDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.
Engy T SaidDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.ORCID 0000-0002-7897-1670
Wendy B AbramsonDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.
Bahareh KhatibiDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.
Brenton S AlexanderDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.ORCID 0000-0003-3657-0673
John J FinneranDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.
Anne M WallaceDepartment of Surgery, University of California San Diego, La Jolla, California, USA.
Ava ArmaniDepartment of Surgery, University of California San Diego, La Jolla, California, USA.
Sarah BlairDepartment of Surgery, University of California San Diego, La Jolla, California, USA.
Marek DobkeDepartment of Surgery, University of California San Diego, La Jolla, California, USA.
Ahmed SulimanDepartment of Surgery, University of California San Diego, La Jolla, California, USA.
Christopher ReidDepartment of Surgery, University of California San Diego, La Jolla, California, USA.
Michael C DonohueDepartment of Neurology, University of Southern California, Los Angeles, California, USA.
Brian M IlfeldDepartment of Anesthesiology, Division of Regional Anesthesia, University of California San Diego, La Jolla, California, USA.
University of California San Diego · USUniversity of Southern California · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundParavertebral and serratus plane blocks are both used to treat pain following breast surgery. However, it remains unknown if the newer serratus block provides comparable analgesia to the decades-old paravertebral technique.

methodsSubjects undergoing unilateral or bilateral non-mastectomy breast surgery were randomized to a single-injection serratus or paravertebral block in a subject-masked fashion (ropivacaine 0.5%; 20 mL unilateral; 16 mL/side bilateral). We hypothesized that (1) analgesia would be non-inferior in the recovery room with serratus blocks (measurement: Numeric Rating Scale), and (2) opioid consumption would be non-inferior with serratus blocks in the operating and recovery rooms. In order to claim that serratus blocks are non-inferior to paravertebral blocks, both hypotheses must be at least non-inferior.

resultsWithin the recovery room, pain scores for participants with serratus blocks (n=49) had a median (IQR) of 4.0 (0-5.5) vs 0 (0-3.0) for those with paravertebral blocks (n=51): 0.95% CI -3.00 to -0.00; p=0.001. However, the difference in morphine equivalents did not reach statistical significance for superiority with the serratus group consuming 14 mg (10-19) vs 10 mg (10-16) for the paravertebral group: 95% CI -4.50 to 0.00, p=0.123. Since the 95% CI lower limit of -4.5 was less than our prespecified margin of -2.0, we failed to conclude non-inferiority of the serratus block with regard to opioid consumption.

conclusionsSerratus blocks provided inferior analgesia compared with paravertebral blocks. Without a dramatic improvement in safety profile for serratus blocks, it appears that paravertebral blocks are superior to serratus blocks for postoperative analgesia after non-mastectomy breast surgery. TRIAL REGISTRATION NUMBER: NCT03860974.

Indexed as

AnalgesiaBreast NeoplasmsNerve BlockFemaleHumansMastectomyPostoperative Painnerve blockpainpostoperativeregional anesthesia

Identifiers

PMID34158376
PMCPMC8380889
OpenAlexW3174633112

What OpenQuestion holds

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LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.