Ultrasound Guided Pectoral Nerve Block (PEC I) versus Serratus Anterior Plane block (SAPB) for Postoperative Analgesia in Modified Radical Mastectomy

Abstract

Abstract Background Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. A procedure called Modified radical mastectomy is now a standard surgical treatment for early stage breast cancers. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Though various risk factors have been suggested, inappropriate acute postoperative pain management has been associated with the development of chronic postmastectomy pain, a complex post-surgical pain syndrome that may occur following any type of breast surgery. Objective To evaluate the effectiveness of ultrasound guided pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in modified radical mastectomy Methods This is Randomized controlled double blind clinical trial was conducted in the operating theatres of Ain Shams University Hospitals for 6 months after approval of ethical committee of faculty of medicine, Ain Shams Univeristy on 64 female patients undergoing Modified Radical Mastectomy divided randomly into two groups, each group consisted of 32 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB). Results There was a statistically significant decrease mean of group II compared to group I according to postoperative systolic blood pressure (mmHg) from 1 hr. to 6 hrs. While there was no statistically significant difference between groups according to postoperative diastolic blood pressure (mmHg). However, a statistically significant decrease mean of group II compared to group I according to postoperative heart rate (beat/min) from 1 hr. to 6 hrs was found. A statistically significant decrease mean of group II compared to group I according to numeric rating score for pain from 1 hr to after 6 hrs also was found. The current study shows highly statistically significant difference between groups according to time of first analgesia (hour), number of patients who received postoperative Diclofenac 75 mg and total consumption of Diclofenac 75 mg. Conclusion SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after modified radical mastectomy under general anesthesia, compared to PEC 1 block.