{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:33:44Z","timestamp":1786739624429,"version":"build-2736575974"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Serratus anterior plane block (SAPB) provides chest wall analgesia in modified radical mastectomy (MRM) surgeries by targeting T2\u2013T6 intercostal nerves, but conventional single-injection techniques show inconsistent T2 and axillary coverage, failing to reliably block the intercostobrachial nerve \u2013 a key contributor to postoperative axillary pain and postmastectomy pain syndrome. MRM patients experience significant axillary pain from dissection-related intercostobrachial nerve (ICBN) injury, necessitating multimodal analgesia that ensures reliable T2-axillary desensitisation. There is inadequate cephalad\/axillary spread in standard SAPB, confirmed by prior studies showing &lt;20% T2 blockade and variable ICBN involvement despite high local anaesthetic volumes. This prospective case series included 10 patients in whom ultrasound-guided deep two-point SAPB was administered with 20 mL of 0.375% ropivacaine at the 5\n                    <jats:sup>th<\/jats:sup>\n                    rib midaxillary line and 10 mL at the 3\n                    <jats:sup>rd<\/jats:sup>\n                    rib anterior axillary line. Sensory mapping via grid, cold\/pin-prick Likert scores, and photography 30 min post-block showed reliable T2\u2013T6 dermatomal desensitisation (70% success: composite score &gt;4) confirmed by heat maps. It is concluded that two-point injection at 3\n                    <jats:sup>rd<\/jats:sup>\n                    and 5\n                    <jats:sup>th<\/jats:sup>\n                    rib enhances T2\/ICBN blockade over single-level SAPB; nevertheless, larger randomised controlled trials are needed for opioid-sparing validation.\n                  <\/jats:p>","DOI":"10.4103\/ija.ija_202_26","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T16:00:44Z","timestamp":1779292844000},"page":"676-680","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Two-point deep serratus anterior plane block for modified radical mastectomy \u2013 A case series assessing axillary coverage using structured sensory mapping"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9614-7476","authenticated-orcid":false,"given":"Sachin","family":"Bansal","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6698-8413","authenticated-orcid":false,"given":"Manisha","family":"Hemrajani","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2236-6699","authenticated-orcid":false,"given":"Pushplata","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3953-3746","authenticated-orcid":false,"given":"Adhiraj","family":"Baruah","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6396-6650","authenticated-orcid":false,"given":"Akanksha","family":"Dutt","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"R1-20260520","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.bjae.2022.08.003","article-title":"Anaesthesia for awake breast surgery","volume":"22","author":"Hamilton","year":"2022","journal-title":"BJA Educ"},{"key":"R2-20260520","first-page":"275","article-title":"Post mastectomy pain syndrome at an Indian tertiary cancer centre and its impact on quality of life","volume":"60","author":"Kakati","year":"2023","journal-title":"Indian J Cancer"},{"key":"R3-20260520","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1097\/MS9.0000000000001622","article-title":"Preservation versus dissection of the intercostobrachial nerve for breast cancer surgeries:A systematic review and meta-analysis","volume":"86","author":"Al-Dardery","year":"2023","journal-title":"Ann Med Surg (Lond)"},{"key":"R4-20260520","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/AAP.0000000000000649","article-title":"Injection volume and anesthetic effect in serratus plane block","volume":"42","author":"Kunigo","year":"2017","journal-title":"Reg Anesth Pain Med"},{"key":"R5-20260520","doi-asserted-by":"crossref","first-page":"S307","DOI":"10.4103\/ija.ija_149_22","article-title":"Analgesic efficacy of superficial versus deep serratus plane block for MRM under general anaesthesia:A randomised comparative study","volume":"66","author":"Bhoi","year":"2022","journal-title":"Indian J Anaesth"},{"key":"R6-20260520","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.bjan.2016.10.009","article-title":"Axillary local anesthetic spread after the thoracic interfacial ultrasound block - A cadaveric and radiological evaluation","volume":"67","author":"Torre","year":"2017","journal-title":"Rev Bras Anestesiol"},{"key":"R7-20260520","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1136\/rapm-2024-105973","article-title":"Randomized comparison between ultrasound-guided proximal and distal approaches of intercostobrachial nerve block as an adjunct to supraclavicular brachial plexus block for upper arm arteriovenous access procedures","volume":"51","author":"Samerchua","year":"2026","journal-title":"Reg Anesth Pain Med"},{"key":"R8-20260520","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4103\/ija.ija_890_23","article-title":"Enhancing ergonomics in rib counting in ultrasound-guided serratus anterior plane block","volume":"68","author":"Bansal","year":"2024","journal-title":"Indian J Anaesth"},{"key":"R9-20260520","doi-asserted-by":"crossref","first-page":"464","DOI":"10.4103\/sja.SJA_822_19","article-title":"Analgesic efficacy and spread of local anesthetic in ultrasound-guided paravertebral, pectoralis II, and serratus anterior plane block for breast surgeries:A randomized controlled trial","volume":"14","author":"Jain","year":"2020","journal-title":"Saudi J Anaesth"},{"key":"R10-20260520","first-page":"854","article-title":"Serratus plane block:A cadaveric study to evaluate optimal injectate spread","volume":"43","author":"Biswas","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"R11-20260520","doi-asserted-by":"crossref","first-page":"e70134","DOI":"10.1111\/aas.70134","article-title":"Spread of injectate after combined deep serratus anterior and superficial parasternal intercostal plane injections:A cadaver study to evaluate their utility in breast surgery","volume":"69","author":"Biswas","year":"2025","journal-title":"Acta Anaesthesiol Scand"},{"issue":"(Suppl 3)","key":"R12-20260520","doi-asserted-by":"crossref","first-page":"S115","DOI":"10.4103\/ija.ija_339_21","article-title":"Evaluation of analgesic efficacy of superficial cervical plexus block in patients undergoing modified radical mastoidectomy:A randomised controlled trial","volume":"65","author":"Deepika","year":"2021","journal-title":"Indian J Anaesth"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_202_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:30:36Z","timestamp":1786735836000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_202_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_202_26","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2026-02-03","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}