Abstract
Background
Postoperative analgesia after reduction mammaplasty remains challenging, particularly given the extent and distribution of surgical dissection. While ultrasound-guided interfascial plane blocks are commonly used, their timing and reliability may be influenced by surgical duration and tissue manipulation. We investigated whether a surgically administered serratus anterior plane block, applied under direct visualization immediately before wound closure, could enhance postoperative analgesia.Methods
In this prospective randomized controlled trial, patients undergoing reduction mammaplasty were assigned to receive either a bilateral surgical serratus anterior plane block in addition to standardized multimodal analgesia or standard analgesia alone. The block was performed intraoperatively by the surgeon without ultrasound guidance. The primary endpoint was cumulative tramadol consumption within the first 24 postoperative hours. Secondary outcomes included postoperative pain intensity, time to first analgesic request, and opioid-related adverse effects.Results
Fifty-six patients completed the study. Patients receiving the surgical serratus anterior plane block demonstrated lower pain scores in the early postoperative period, while pain intensity became comparable between groups later during follow-up. Despite this convergence, opioid consumption remained consistently lower in the block group throughout the first 24 hours, with a 43% reduction in cumulative tramadol use at 24 hours. In addition, the time to first postoperative analgesic demand was significantly prolonged in the block group. No block-related complications were observed.Conclusion
A surgically performed serratus anterior plane block applied immediately before wound closure was associated with a sustained opioid-sparing effect after reduction mammaplasty. This intraoperative approach may offer a practical alternative to ultrasound-guided techniques; however, further studies are required to refine the technique and define its role within enhanced recovery pathways.Level of evidence ii
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