An interventional study of Serratus Anterior Plane Block (SAPB) and Midpoint transverse process to pleura (MTP) block in Modified Radical Mastectomy, Postoperative Analgesia and Mid-point Transverse Process to Pleura Block, sponsored by Ain Shams University. Completed at 1 site in Egypt. Open to female participants aged 35 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-10-07.
Sponsored by Ain Shams University · Not applicable, Interventional, and Treatment
This study aimed to compare the analgesic efficacy of ultrasound-guided mid-point transverse process-to-pleura block versus serratus anterior plane block after unilateral modified radical mastectomy.
Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women.
After the application of ultrasound in anaesthetic practice, several blocks have been described recently, Serratus anterior plane blocks performed at the axillary fossa within a region bounded by the anterior and posterior axillary lines and th 3rd to 6th ribs, in which the intercostobrachialis nerve, lateral cutaneous branches of the intercostal nerves (T2-T9),long thoracic nerve, and the thoracodorsal nerve are located in a compartment between the serratus anterior and the latissimus dorsi muscles.
The MTP block is a new block described for thoracic surgery, it involves deposition of the local anesthetic drug midway between the transverse process and the pleura. Postulated that the local anesthetic deposited at this point will reach the paravertebral space through several possible mechanisms, such as medially through the gap between the superior costotransverse ligament (SCTL) and vertebral bodies, through fenestrations in SCTL, and laterally through the internal intercostal membrane, the neural target will be the dorsal and ventral rami of spinal nerves, spanning 1-3 levels cranial and caudal to the level of injection, the advantage of the MTP block over the conventional thoracic paravertebral block is that the visualization of SCTL is not required, which might be difficult in patients with obesity. The second advantage is that the target point of the needle is very superficial and far from structures, such as the pleura and neurovascular bundles ,making this novel block much safer.
Ain Shams University is the lead sponsor of 1,876 studies on the registry; 423 are open to participants now.
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Exclusion Criteria:
Group I: (Serratus Anterior Plane Block (SAPB) Group) (n=15): The patient will lay on her side with arm brought forward, the linear US transducer probe (10-12 MHz) will be placed in the midaxillary line and then moved caudal from second rib until the sixth intercostal space. At this point, the subcutaneous tissue and serratus muscle will be identified in the superficial plane, whereas the external intercostal muscles will be identified in the intermediate plane and finally in the deep plane the ribs, pleura and lung will be identified. The needle will be advanced from caudal to cranial direction. In-plane technique will be used until the tip of the needle placed between the serratus anterior muscle and the external intercostal muscle (deep SABP) (Blanco et al., 2013). A volume of titrated bolus of 20 ml of bupivacaine 0.5% will be injected after aspiration to avoid intravascular injection (Lin J et al., 2020).
Procedure: Serratus Anterior Plane Block (SAPB)
GroupII: (Midpoint transverse process to pleura (MTP) block group )(n=15): In the lateral postion, the T4 spine will be counted by ultrasound, and high frequency linear US transducer probe (10-12 MHz) will be placed longitudinally, approximately 2.5 cm lateral to the midline the needle will be advanced in plane from cranial to caudal direction. The desired end point for the needle tip will be the midpoint of the line between the posterior border of the transverse process of T4 and the pleura(injection will be deep (anterior) to the posterior aspect of the vertebral transverse process but superficial to the superior costotransverse ligment),the needle tip dose not enter the paravertebral space (Chin et al., 2021), a volume of titrated bolus of 20 ml of bupivacaine 0.5% will be injected after aspiration to avoid intravascular injection,pleural displacement and bowing of erector spinae will be observed at the side of injection (Syal et al., 2020; Pusch et al., 2000).
Procedure: Midpoint transverse process to pleura (MTP) block
Group I: (Serratus Anterior Plane Block (SAPB) Group) (n=15): The patient will lay on her side with arm brought forward, the linear US transducer probe (10-12 MHz) will be placed in the midaxillary line and then moved caudal from second rib until the sixth intercostal space. At this point, the subcutaneous tissue and serratus muscle will be identified in the superficial plane, whereas the external intercostal muscles will be identified in the intermediate plane and finally in the deep plane the ribs, pleura and lung will be identified. The needle will be advanced from caudal to cranial direction. In-plane technique will be used until the tip of the needle placed between the serratus anterior muscle and the external intercostal muscle (deep SABP) . A volume of titrated bolus of 20 ml of bupivacaine 0.5% will be injected after aspiration to avoid intravascular injection.
In the lateral postion, the T4 spine will be counted by ultrasound, and high frequency linear US transducer probe (10-12 MHz) will be placed longitudinally, approximately 2.5 cm lateral to the midline the needle will be advanced in plane from cranial to caudal direction. The desired end point for the needle tip will be the midpoint of the line between the posterior border of the transverse process of T4 and the pleura(injection will be deep (anterior) to the posterior aspect of the vertebral transverse process but superficial to the superior costotransverse ligment),the needle tip dose not enter the paravertebral space , a volume of titrated bolus of 20 ml of bupivacaine 0.5% will be injected after aspiration to avoid intravascular injection,pleural displacement and bowing of erector spinae will be observed at the side of injection .
Time to first rescue analgesia
Time to first rescue analgesia was recorded from the end of surgery to first diclofenac administration.
Time frame: 24 hours postoperatively
The total number of doses of the rescue analgesia
The total number of doses of the rescue analgesia that was received in the 24 hours postoperatively if the NRS pain score at rest ≥4, Numeric Rating Scale (NRS) at rest and at movement (cough or rotating the body).
Time frame: 24 hours postoperatively
Degree of pain
Pain was assessed using an 11-point Numeric Rating Scale (NRS) (0=no pain, 1-3 mild, 4-7 moderate, 7-10 severe) at rest and during movement. Pain scores were recorded at 0, 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively.
Time frame: 24 hours postoperatively
Objective Pain Score
Objective Pain Score (OPS) was used to assess the degree of pain (1=inadequate pain relief/pain at rest; 2=pain-free at rest but pain with deep breathing; 3=pain-free with deep breathing but pain with coughing; 4=pain-free even with coughing).
Time frame: 24 hours postoperatively
Heart rate
Heart rate was recorded at baseline, 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively.
Time frame: 24 hours postoperatively
Mean arterial pressure
Mean arterial pressure was recorded at baseline, 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively.
Time frame: 24 hours postoperatively
Incidence of adverse events
Incidence of adverse events such as nausea and vomiting were recorded.
Time frame: 24 hours postoperatively
Incidence of block-related complications
Incidence of block-related complications such as local anesthetic toxicity and pneumothorax were recorded.
Time frame: 24 hours postoperatively
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
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Ain Shams University