Effects of rhomboid intercostal nerve, serratus anterior plane, and paravertebral block on the quality of recovery after breast cancer surgery: A randomized controlled clinical trial

Nerve blocks are among the most important methods of postoperative analgesia in breast cancer surgery. We used a randomized controlled clinical trial to compare the effects of rhomboid intercostal nerve block (RIB), serratus anterior plane block (SAPB), and paravertebral block (PVB) on the postoperative quality of recovery and postoperative analgesia in modified radical mastectomy. A total of 132 breast cancer surgery patients were randomized 1:1:1 into three groups. 0.375% ropivacaine 20 ml for ultrasound-guided RIB (RIB group, n = 44), SAPB (SAPB group, n = 44), and PVB (PVB group, n = 44). The primary outcome was the QoR-40 score at 24 hours after surgery. The postoperative 24-hour QoR-40 scores of the RIB (median: 186; interquartile range: 177, 190.5) and PVB (median: 186.5; interquartile range: 176.25, 190.5) groups were higher than those of the SAPB group (median: 168; interquartile range: 163.25, 172) ( P  < 0.001). In addition, the intraoperative sufentanil consumption ( P  < 0.001), number of intraoperative sufentanil users ( P  < 0.001), and postintubation NRS scores ( P  = 0.01) of the RIB and PVB groups were significantly lower than those of the SAPB group, but there was no statistically significant difference between the RIB and PVB groups. Compared with SAPB, RIB and PVB improve the quality of postoperative recovery, reduce intraoperative opioid use, and improve early postoperative analgesia. RIB may be one of the best alternatives to PVB as a facial plane block.