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Effects of Ropivacaine Concentration on Analgesia After Ultrasound-Guided Serratus Anterior Plane Block: A Randomized Double-Blind Trial

Authors Huang L, Zheng L, Wu B, Chen Z, Chen J, Xu X, Shi K

Received 2 September 2019

Accepted for publication 24 December 2019

Published 10 January 2020 Volume 2020:13 Pages 57—64

DOI https://doi.org/10.2147/JPR.S229523

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Michael A Überall


Lvdan Huang,* Liangyu Zheng,* Bingjing Wu,* Zhengjie Chen, Jiali Chen, Xuzhong Xu, Kejian Shi

Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Kejian Shi; Xuzhong Xu
Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Town, Wenzhou, Zhejiang, People’s Republic of China
Tel +86 13868889697;
+86 13706657799
Fax +86 55578999 Ext 669697;
+86 55578999 Ext 667799
Email wzshikejian@163.com; xuzhong@263.net

Purpose: Serratus anterior plane (SAP) block is effective for analgesia after breast surgery. Whether a higher local anesthetic concentration prolongs sensory block duration and improves postoperative analgesia remains unclear. The aim of this study was to compare the analgesic effects of SAP block with different concentrations of ropivacaine.
Patients and Methods: Sixty patients scheduled for breast surgery were enrolled in this randomized double-blind trial. SAP block was induced with 20 mL of 0.375%, 0.5%, or 0.75% ropivacaine in Group R0.375, Group R0.5, and Group R0.75, respectively. The primary endpoint was the area under the curve (AUC) of numerical rating scale (NRS) pain intensity scores at rest over time. The secondary endpoints were AUC of NRS pain intensity scores on movement over time, active sensory block duration, tramadol consumption, and the elapsed time between completion of surgery and the first administration of rescue analgesia.
Results: The AUC of NRS pain intensity scores at rest of Group R0.375 was significantly higher than that of Groups R0.5 and R0.75 (P=0.025, and P=0.001). The AUC of NRS pain intensity scores on movement of Group R0.375 was also significantly higher than that of Groups R0.5 and R0.75 (both P< 0.001). At higher ropivacaine concentrations, the duration of SAP sensory block increased (P< 0.001). Tramadol consumption and the elapsed time between completion of surgery and the first administration of rescue analgesia were similar in the three groups (P> 0.05).
Conclusion: A comparison of 0.5% and 0.75% ropivacaine showed no significant difference in postoperative analgesia, but both were superior to 0.375% ropivacaine, although higher ropivacaine concentration lengthened the duration of SAP block. Therefore, SAP block with 0.5% ropivacaine is recommended for postoperative analgesia in breast surgery.

Keywords: analgesia, ultrasound, regional anesthesia, breast


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