Comparative study between the analgesic efficacy of pectoralis major block II versus erector spinae block versus paravertebral block in postoperative analgesia in modified radical mastectomy

Abstract

Introduction: Breast cancer surgeries are common surgical procedures, particularly in middle-aged women. Ultrasound guided chest wall blocks have become popular for regional analgesia in breast surgery. Objectives: Comparison between the analgesic efficacy of Pectoralis Major II (PECS II), paravertebral (PVB) and erector spinae (ESPB) blocks in analgesia postoperatively in modified radical mastectomy (MRM). Material and Methods: This prospective randomized comparative clinical study was conducted on 150 female patients, 30-70 years-old, ASA I–II, for unilateral elective MRM with axillary clearance, randomized into 3 groups each received ultrasound guided PECS II, or ESPB or PVB then followed up for 24 hours postoperatively. The primary outcome compared between the postoperative analgesic effect of PECS II with ESPB with PVB by Visual Analogue Score (VAS). The secondary outcomes compared total morphine consumption 24 hours postoperatively, sensory blockage and duration of block. Results: VAS in PECS II had lower score 24 hours postoperative. According to morphine consumption, PECS II had less morphine consumption than the other two groups. ESPB had prolonged duration of block followed by PVB with slight difference to PECS II. Regarding to axillary clearance, PECS II was the best in particular to coverage of axillary clearance. Conclusion: PECS II block is better than ESP block and PVB regarding analgesia starting from 0.5 hr. till 24 h postoperatively, with less narcotic consumption and better sensory blockage.