Serratus anterior plane block: Anatomical landmark-guided technique

In landmark-guided SAPB, our aim is to deposit the local anesthetic (LA) in the fascial plane deep to serratus anterior muscle (SAM) and above the ribs or external intercostal muscle [Figure 1]a. It is performed in lateral decubitus position with the nondependent arm flexed, abducted and raised over head, or in supine position with the ipsilateral arm abducted. Case 2 A 60-year-old lady who had undergone left modified radical mastectomy 2 years back, presented with pain along the site of incision and inner side of left arm. The drug injected in deep serratus plane spreads in both cephalocaudal and anteroposterior directions over several levels depending on the volume of LA administered [Figure 1]d. Although it is simple and easy to perform, a randomized controlled trial is required to validate its efficacy, safety, and reliability compared with PNS or ultrasound-guided techniques.