A Novel USG-Guided PEC Block with Ropivacaine and Fentanyl for Postoperative Analgesia in Chest Wall Surgeries: A Randomized Controlled Trial

Abstract

Background: Perioperative analgesia can be administered through various routes to patients undergoing chest wall surgeries. A recently introduced technique is the ultrasound-guided pectoral nerve block, which aims to alleviate pain effectively. Objectives: The purpose of this study is to investigate and compare the total duration of analgesia and the timing of the first rescue analgesia. Methods: In this prospective, randomized, triple-blind study, 60 adult patients scheduled for elective chest wall surgeries were enrolled. They were randomly divided into two equal groups: Group R received 38 mL of 0.2% ropivacaine and 2 ml of normal saline, and group F received 38 mL of 0.2% ropivacaine and 2 mL of fentanyl (100 mcg). All patients were administered general anesthesia and the PEC1 and PEC2 blocks postoperatively prior to extubation. The primary objective was to assess the total duration of postoperative analgesia, the Numeric Rating Scale (NRS) pain score, and the time to first rescue analgesia in both groups. The secondary outcome was the total consumption of postoperative analgesics. Results: The total duration of analgesia, as well as the consumption of paracetamol and fentanyl postoperatively in group F, were 11.02 ± 2.01 hours, 1.5 ± 0.5 g, and 0 mcg, respectively. In contrast, in group R, these were 8.28 ± 0.51 hours, 2.2 ± 0.8 grams, and 35.1 ± 13.4 mcg, respectively. The NRS scores at rest and during movement in group F were lower compared to group R. Conclusions: Ultrasound-guided PEC1 and PEC2 blocks with fentanyl as an adjuvant to ropivacaine have significantly reduced the requirements for analgesia and pain scores.