Ding Zewu, Wang Xihui, Han Dongdong, Zhang Can, Xie Kangjie, Zhou Huidan, Yuan Xiaohong, Mao Xiaochun, Yu Weifeng, Huang Zhangxiang
Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences Hangzhou 310005, Zhejiang, China.
Department of Anesthesiology, Shaoxing People's Hospital Shaoxing 312300, Zhejiang, China.
Am J Transl Res. 2025 Jul 15;17(7):5090-5099. doi: 10.62347/PUCP3777. eCollection 2025.
The newly introduced retrolaminar block (RLB) offers anesthesiologists an alternative regional anesthetic technique for radical mastectomy. However, few clinical studies have compared the efficacy of RLB with that of serratus anterior plane block (SAPB). This study aimed to investigate the postoperative analgesia efficacy between ultrasound-guided RLB and SAPB in patients undergoing radical mastectomy.
Seventy patients were included in this prospective, randomized controlled trial. Patients were assigned to receive either ultrasound-guided RLB or SAPB. The primary outcome was the visual analogue scale (VAS) score during coughing at 6 hours postoperatively. The secondary indicators included dermatomal spread of sensory block (from T2 to T6 at the medial and lateral nipple lines assessed by acupuncture), intraoperative hemodynamic changes, and analgesia-related adverse reactions.
The median VAS scores during coughing at 6 hours postoperatively were 2 (IQ1-IQ3: 1-3; P = 0.39) in both groups, indicating no significant difference. Similar analgesic effects were observed at other time points within 48 hours post-surgery. RLB provided broader sensory coverage on the medial side of the nipple compared to SAPB (median [IQR]: 3 (3-4) and 2 (1-2)) (P = 0.006). No significant differences in mean arterial pressure (MAP) or heart rate (HR) were observed immediately or 5 minutes after skin incision. The incidence of adverse events did not differ significantly between the two groups.
Retrolaminar block and Serratus anterior plane block provide comparable postoperative analgesia following radical mastectomy. However, RLB offers a broader sensory block range, particularly over the medial chest wall.
新引入的椎板后阻滞（RLB）为麻醉医生提供了一种用于根治性乳房切除术的替代性区域麻醉技术。然而，很少有临床研究比较RLB与前锯肌平面阻滞（SAPB）的疗效。本研究旨在调查超声引导下RLB与SAPB在根治性乳房切除患者中的术后镇痛效果。
本前瞻性随机对照试验纳入了70例患者。患者被分配接受超声引导下的RLB或SAPB。主要结局是术后6小时咳嗽时的视觉模拟评分（VAS）。次要指标包括感觉阻滞的皮节扩散（通过针刺评估乳头中线和外侧线从T2至T6）、术中血流动力学变化以及与镇痛相关的不良反应。
两组术后6小时咳嗽时的VAS评分中位数均为2（四分位间距：1 - 3；P = 0.39），表明无显著差异。在术后48小时内的其他时间点观察到类似的镇痛效果。与SAPB相比，RLB在乳头内侧提供了更广泛的感觉覆盖（中位数[四分位间距]：3（3 - 4）和2（1 - 2））（P = 0.006）。在皮肤切开即刻或5分钟后，平均动脉压（MAP）或心率（HR）无显著差异。两组不良事件的发生率无显著差异。
椎板后阻滞和前锯肌平面阻滞在根治性乳房切除术后提供了相当的术后镇痛效果。然而，RLB提供了更广泛的感觉阻滞范围，特别是在胸壁内侧。
