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Background and Aims Ultrasound-guided deep Serratus Anterior Plane Block (SAPB) has shown effective analgesia in breast surgeries. We hypothesized that a surgeon-administered SAPB under direct vision at end of surgery provides superior analgesia to placebo. To assess the efficacy of SAPB under vision versus saline placebo in breast surgeries with respect to pain scores.Methods In this double-blind randomized controlled trial, patients undergoing simple or modified radical mastectomy with axillary clearance post-chemotherapy were randomized into two groups. The study arm received 20 mL of 0.25% Levobupivacaine, and the control arm received normal saline. Maximum pain score within 24 hours was the primary outcome. Pain, nausea, vomiting, and sedation scores were recorded at shifting, 1 hour, 2 hours, and the next morning. Tramadol 50 mg and Metoclopramide 10 mg were used as rescue analgesic and antiemetic.Results Moderate pain was observed in 46.5% of the control group and 33.3% of the study group (p = 0.434). Immediate post-op pain scores at rest (p = 0.049) and on movement (p = 0.029), and vomiting at 1 hour (p = 0.049), were significantly lower in the study arm. Fewer patients required rescue analgesics in the study arm, though not statistically significant. Sedation, nausea, total opioid use, and time to analgesic were similar between groups.Conclusions Deep SAPB showed benefit in early pain relief and reduced vomiting at 1 hour. Though overall outcomes were statistically similar, SAPB shows promise in postoperative analgesia and warrants further study.