Analgesic efficacy of ultrasound-guided PECS II and transeversus thoracic plane blocks compared to serratus anterior plane block for modified radical mastectomy: A randomized prospective study

Abstract

Background: Chronic pain and discomfort after breast cancer surgery could be reduced by improving acute postoperative pain management. Aim: The aim is to compare the analgesic effectiveness of ultrasonography (US) guided serratus anterior plane (SAP) block vs combined modified pectoral nerve (PECS II) and transeversus thoracic plane (TTP) blocks by for modified radical mastectomy patients. The study was registered on Clinicaltrials.gov with registration code: NCT04908878 Patients and methods: 70 patients were divided into two equal groups (35 each). After induction of general anesthesia, Group I got unilateral us-guided PECS II-TTP blocks on the procedure side. Group II: received unilateral us-guided SAP block on the operation side. The 24 hours’ postoperative morphine consumption (mg) was the primary outcome. Secondary outcomes were VAS score, time to first need for rescue analgesia, patient satisfaction and complications. Results: In combined PECS II-TTP blocks there was a significant decrease in the 24 hours’ postoperative morphine consumption [median (IQR); 3 (3, 6) and 9 (9, 12) mg], VAS scores [median (IQR); 3 (2, 3), 3 (3, 4) at 4 hrs. and 3 (3, 3), 3 (3, 5) at 6 hrs. in group I and II respectively] and prolonged time for 1st rescue analgesia [median (IQR); 8 (6, 12) and 6 (4, 8) hrs in group I and II respectively]. While, there were no significant differences between the two groups in intra-operative fentanyl consumption, hemodynamics or complication. Conclusion: The PECS II-TTP blocks provide effective and long-lasting postoperative analgesia than SAP block in modified radical mastectomy.