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“A Tale of Two Planes”: Deep Versus Superficial Serratus Plane Block for Postmastectomy Pain Syndrome

Piracha, Mohammad M. MD; Thorp, Stephen L. MD; Puttanniah, Vinay MD; Gulati, Amitabh MD

Regional Anesthesia & Pain Medicine: March/April 2017 - Volume 42 - Issue 2 - p 259–262
doi: 10.1097/AAP.0000000000000555
Chronic and Interventional Pain: Brief Technical Report

Introduction: Postmastectomy pain syndrome (PMPS) is a significant burden for breast cancer survivors. Although multiple therapies have been described, an evolving field of serratus anterior plane blocks has been described in this population. We describe the addition of the deep serratus anterior plane block (DSPB) for PMPS.

Methods: Four patients with history of PMPS underwent DSPB for anterior chest wall pain. A retrospective review of these patients' outcomes was obtained through postprocedure interviews.

Results: Three of the patients previously had a superficial serratus anterior plane block, which was not as efficacious as the DSPB. The fourth patient had a superficial serratus anterior plane that was difficult to separate with hydrodissection but had improved pain control with a DSPB.

Conclusions: We illustrate 4 patients who have benefitted from a DSPB and describe indications that this block may be more efficacious than a superficial serratus plane block. Further study is recommended to understand the intercostal nerve branches within the lateral and anterior muscular chest wall planes.

From the *Department of Anesthesiology, Weill Medical College of Cornell University and New York Presbyterian Hospital; and †Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY.

Accepted for publication November 14, 2016.

Address correspondence to: Amitabh Gulati, MD, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, 1275 York Ave, M-308, New York, NY 10065 (e-mail: gulatia@mskcc.org).

This work was supported in part by a Memorial Sloan Kettering Cancer Center Support Grant (P30 Core Grant, National Institutes of Health) and departmental funding from the Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY.

The authors declare no conflict of interest.

Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.