Analgesic effect of adding modified pectoral nerve block to serratus anterior plane block in modified radical mastectomy: Randomized double-blinded trial

Abstract

ABSTRACT Objective Acute, severe pain following breast surgery affects about 40% of individuals. It has proven possible to lessen postoperative pain related to modified radical mastectomy (MRM) by developing several thoracic wall blocks. This study evaluated the analgesic benefit of pectoral nerve block type 2 (PECS II) in conjunction with ultrasonography-guided serratus anterior plane block (SAPB) as opposed to SAPB alone in patients undergoing MRM. Methods In this randomized double-blind trial, female patients undergoing MRM under general anesthesia were randomly assigned to the SAPB Group (n = 30) or the Combined Group (n = 30). Along with block-related problems, the total amount of fentanyl consumed during the procedure and the amount of morphine consumed over in the first 24 hours after surgery were noted. During rest and movement, pain was measured using the Numeric Rating Scale (NRS). Results The total intraoperative fentanyl consumption was reduced to 130.7 ± 44.4 µg in the combined group compared to 160.0 ± 53.2 µg in the SAPB group (p = 0.024). Also, postoperative morphine consumption was 1.5 mg (0–6) and 6 mg (3–9) in the two groups, respectively (p = 0.005). The Combined group showed significantly lower scores of NRS at rest and during movement than the SABP group throughout the postoperative period. Conclusion Ultrasound-guided SAPB plus PECS II block provides safer and more efficient analgesia in MRM than SABP alone, as evidenced by decreased postoperative morphine consumption, pain scores, and intraoperative fentanyl consumption.