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 1^st 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.

KEYWORDS:

• Mastectomy
• transeversus thoracic plane block
• serratus anterior plane block
• PECS II block

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Alshaimaa Soliman Alasrag and Amira Mahfouz Elkeblawy. The first draft of the manuscript was written by Hoda Alsaid Ahmed Ezz and Mohammed Mohye Eldin Abo Elyazid, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Irb

The Research Ethics Committee of the Faculty of Medicine, Tanta, Egypt, approval code: 33972/7/20.

Sponsors and funding sources

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Additional information

Funding

self funded