Clinical Research Directory

Patients will be positioned in the lateral position, The thoracic vertebrae spinous process convenient to level of incision (T5-T7:the level which covers thoracic area) will be identified and the transducer will be placed approximately to 2-3 cm lateral to midline ,The needle tip will be advanced until it is located in the interfascial plane deep to the erector spinae muscle group and superior to the transverse process. Once in position, 30 ml bupivacaine 0.25% will be injected under ultrasound guidance. Correct needle-tip position will be confirmed by the presence of linear spread between the transverse process and the presence of linear spread between the transverse process and the erector spinae muscle group.

Serratus anterior plane block will be performed with the patient in the supine position , The probe will be placed in a sagittal position, the mid-axillary region of the thoracic cage. The needle will be advanced with an in-plane technique and 20 ml bupivacaine 0.25% will be injected . PECS block will be performed at the same position. The ultrasound probe will be placed obliquely over the lateral third of the clavicle. the needle will be advanced, in the same plane as the probe, from the medial to lateral direction ,10 ml 0.25% bupivacaine will be injected. Then the needle will be advanced to the fascial plane between the pectoralis minor and serratus anterior muscles, at which point an additional 10 ml 0.25% bupivacaine will be administered.