Serratus Anterior Plane Block with Methylene Blue and Ropivacaine for analgesia in Prosthetic Breast Augmentation: A Randomized Controlled Trial.

Summary

In a double-blind randomized trial of 72 women undergoing axillary prosthetic breast augmentation, serratus anterior plane block improved early postoperative pain. Adding methylene blue to ropivacaine did not improve pain at 6 hours but produced significantly lower VAS scores at 24, 48, and 72 hours versus ropivacaine alone, indicating prolonged analgesia.

Key Findings

• SAPB improved postoperative pain control within 24 hours compared with standard care.
• Ropivacaine + methylene blue yielded significantly lower VAS scores than ropivacaine alone at 24, 48, and 72 hours (P < 0.05).
• No baseline imbalances across groups in age, BMI, implant brand, size, or type; no early (6 h) advantage with methylene blue.

Clinical Implications

Consider adding methylene blue to ropivacaine for serratus plane blocks in axillary breast augmentation to extend analgesia through 72 hours, potentially reducing rescue analgesics.

Limitations

• Single-center trial with modest sample size (n=72) limits generalizability
• Safety outcomes and adverse events were not detailed beyond efficacy timepoints

Future Directions

Confirm in multicenter trials, evaluate dose-response for methylene blue, assess opioid-sparing effects and safety (e.g., skin staining, neurotoxicity) and broader cosmetic procedures.