Our Summary

This study looked at the effect of a specific type of pain relief method, called ultrasound-guided serratus plane block (SPB), on patients undergoing a certain type of breast cancer surgery called modified radical mastectomy (MRM) and a procedure to remove lymph nodes in the armpit, known as axillary dissection (AD). These surgeries are often associated with moderate to severe pain.

The study involved 60 patients, who were divided into two groups. One group received the SPB treatment, while the other (the control group) received a saline injection. After surgery, both groups received additional pain relief as needed.

The researchers found that the group receiving the SPB treatment had lower pain scores in the first few hours after surgery and used less opioid pain medication. However, the SPB treatment did not have an impact on longer-term pain or quality of life for these patients.

In simpler terms, the SPB treatment seemed to help with immediate post-surgery pain but didn’t make a difference in the long run.

FAQs

  1. What is the ultrasound-guided serratus plane block (SPB) method for pain relief?
  2. Did the SPB treatment have any impact on long-term pain management and quality of life in patients?
  3. How did the use of opioid pain medication differ between patients receiving SPB treatment and those in the control group after surgery?

Doctor’s Tip

A doctor may advise a patient undergoing a radical mastectomy to consider discussing with their healthcare provider the option of receiving ultrasound-guided serratus plane block (SPB) as a pain relief method immediately after surgery. This may help reduce pain in the first few hours following the procedure and potentially decrease the need for opioid pain medication. However, it is important to note that this treatment may not have a long-term effect on pain or quality of life. It is always recommended to follow up with your healthcare provider for personalized advice and guidance on pain management after surgery.

Suitable For

Radical mastectomy, which involves the removal of the entire breast, underlying chest muscles, and lymph nodes in the armpit, is typically recommended for patients with larger or more aggressive breast tumors, or those with extensive involvement of the lymph nodes. This type of surgery is less common now due to advancements in breast cancer treatment, such as chemotherapy and targeted therapy, which have allowed for more conservative surgical approaches like lumpectomy or partial mastectomy.

Patients who may be recommended for a radical mastectomy include those with:

  • Large or locally advanced breast tumors
  • Inflammatory breast cancer
  • Recurrent or persistent breast cancer
  • Genetic mutations (such as BRCA1 or BRCA2) that increase the risk of breast cancer
  • Patients who are not candidates for breast-conserving surgery due to tumor size, location, or other factors

It is important for patients to discuss their individual situation with their healthcare team to determine the most appropriate treatment plan for them.

Timeline

  • Before radical mastectomy:
  1. Patient is diagnosed with breast cancer and discusses treatment options with their healthcare provider.
  2. Patient undergoes pre-operative tests and consultations to prepare for surgery.
  3. Patient may undergo chemotherapy or radiation therapy before surgery to shrink the tumor.
  4. Patient discusses post-operative care and potential side effects with their healthcare team.
  • After radical mastectomy:
  1. Patient undergoes surgery to remove the breast tissue, lymph nodes, and sometimes chest wall muscles.
  2. Patient wakes up in recovery and may experience pain, swelling, and discomfort.
  3. Patient is monitored closely for any complications or signs of infection.
  4. Patient receives pain medication and wound care instructions to manage post-operative pain and promote healing.
  5. Patient may undergo additional treatments such as chemotherapy, radiation therapy, or hormone therapy to reduce the risk of cancer recurrence.
  6. Patient attends follow-up appointments with their healthcare team to monitor recovery and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about radical mastectomy include:

  1. What are the potential benefits of ultrasound-guided serratus plane block (SPB) for pain relief during and after surgery?
  2. What are the potential risks or side effects associated with SPB treatment?
  3. How does SPB compare to other pain relief methods in terms of effectiveness?
  4. How long does the pain relief from SPB typically last?
  5. Will I still need to take opioid pain medication after surgery if I receive SPB treatment?
  6. How will SPB treatment affect my recovery and overall quality of life post-surgery?
  7. Are there any specific factors that may make me a better or worse candidate for SPB treatment?
  8. How common is SPB treatment for patients undergoing modified radical mastectomy and axillary dissection?
  9. Will I need any additional monitoring or follow-up care if I choose to receive SPB treatment?
  10. Are there any additional resources or support available to help me manage pain during my recovery process?

Reference

Authors: Sulak M, Ahiskalioglu A, Yayik A, Karadeniz E, Celik M, Demir U, Ari M, Alici H. Journal: Anaesthesiol Intensive Ther. 2022;54(1):48-55. doi: 10.5114/ait.2022.114203. PMID: 35266378