Serratus-Intercostal Plane Block versus Erector-Spinae Plane Block for Post-Mastectomy Pain Relief

Abstract

Background: Post-mastectomy pain remains a major clinical concern because inadequate control of acute postoperative pain can delay recovery, increase opioid requirements, and contribute to chronic post-mastectomy pain syndrome. Ultrasound-guided fascial plane blocks, particularly the serratus-intercostal plane block (SIPB) and the erector-spinae plane block (ESPB), have emerged as practical components of multimodal analgesia for breast surgery.

Aim: This review aims to compare the anatomical basis, analgesic coverage, clinical efficacy, safety, advantages, and limitations of SIPB and ESPB for post-mastectomy pain.

Conclusion: Both SIPB and ESPB can improve postoperative pain control and reduce opioid consumption after mastectomy. SIPB is superficial, technically simple, and well suited to procedures involving the anterolateral chest wall and axilla, whereas ESPB generally provides broader multidermatomal coverage that may include the anterior, lateral, and posterior thoracic walls, although its spread can be variable. Selection of the block should therefore be individualized according to surgical extent, required dermatomal coverage, patient factors, and clinician expertise.