Optimal Injection Site for Serratus Anterior Plane Block in Reconstructive Breast Surgery

Analgesia for reconstructive breast surgery can be a challenging undertaking; these women
have often been through painful mastectomy procedures coupled with the mental and physical
discomfort of chemotherapy and its attendant side effects. Additionally, the surgery itself
can provoke significant pain; often requiring extensive dissection of soft tissue and muscle
to provide flap coverage as well the real discomfort of tissue expansion. The literature has
described 2 possible injection sites for the Serratus Anterior Block, however, no study has
defined optimal location based on analgesia and duration. Patients will be randomized to
receive a "deep" Serratus Anterior Block (DSAB) where local anesthetic is deposited deep to
the serratus or a "superficial" Serratus Anterior Block (SSAB) where the local anesthetic is
placed between serratus and latissimus dorsi. The investigator will then evaluate the
difference based on pain scores, opiate consumption, length of hospital stay, as well as
nausea and vomiting.

Inclusion Criteria:

- Patients undergoing reconstructive breast surgery

Exclusion Criteria:

- Patients with allergies to the local anesthetic

- Patients who do no consent to regional anesthesia

- Patients in which serratus block would be contraindicated

- Patients whose anatomy preclude placement of the block