This prospective, single-center observational study will compare postoperative pain control in adults undergoing elective breast surgery. Ninety participants will be evaluated in three groups based on routine clinical care: rhomboid intercostal plane block, serratus posterior superior intercostal plane block, and control. The anesthesia method and fascial plane block will be selected by the treating anesthesiologist, and the research team will not assign participants to a group. The main outcome is the total amount of tramadol used through patient-controlled analgesia during the first 24 hours after surgery. Pain scores at rest and during movement, sensory block levels, postoperative nausea and vomiting, and block-related complications will also be recorded.
Age 18 to 80 years
American society of anesthesiologists physical status I to III
Undergoing surgery under general anesthesia
Provision of written informed consent
History of allergy to local anesthetic medications
Coagulation disorder
Body mass index greater than 40 kg/m2
Infection at the block application site
Participants aged 18 to 80 years who are scheduled for elective breast surgery under general anesthesia at the single study center, provide written informed consent, and meet all eligibility criteria.
Cohort
Prospective
Rhomboid intercostal plane block
Procedure/SurgeryA fascial plane block in which local anesthetic is injected into the plane between the rhomboid major and intercostal muscles. The treating anesthesiologist selects the technique as part of routine clinical care, and the type and dose of local anesthetic used are recorded.
Serratus posterior superior intercostal plane block
Procedure/SurgeryA fascial plane block in which local anesthetic is injected into the plane between the serratus posterior superior and intercostal muscles. The treating anesthesiologist selects the technique as part of routine clinical care, and the type and dose of local anesthetic used are recorded.
Control Group
Procedure/SurgeryParticipants managed with intravenous patient-controlled analgesia as selected by the responsible anesthesiologist during routine clinical care.
Cumulative Tramadol Consumption During the First 24 Hours After Surgery
The total amount of tramadol consumed through the patient-controlled analgesia device will be recorded in milligrams at postoperative hour 24.
Numeric Rating Scale Pain Score at Rest
Pain intensity at rest will be assessed using a Numeric Rating Scale from 0 to 10, where 0 indicates no pain and 10 indicates the most severe pain.
Numeric Rating Scale Pain Score During Movement
Pain intensity during movement, including coughing or deep breathing, will be assessed using a Numeric Rating Scale from 0 to 10, where 0 indicates no pain and 10 indicates the most severe pain.
Dermatomal Extent of Sensory Block Assessed by Pinprick
Among participants in the block groups, sensory block will be assessed by pinprick, and the upper and lower dermatomal boundaries will be recorded.
Incidence of Postoperative Nausea and Vomiting
The occurrence of postoperative nausea and vomiting will be recorded for each participant.
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