Comparative Study between Pectoral Nerve Block Type-II (PECS II) and Serratus Anterior Plane Block (SAPB) in Postoperative Analgesic Efficacy 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. Aim of the Work The aim of this work is to evaluate the efficacy of ultrasound guided pectoral nerve block type two versus Serratus Anterior plane block regarding postoperative pain control in patients undergoing modified radical mastectomy. Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 70 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 35 patients; Group I patients received pectoral nerve block type two (PECS II), Group II patients received Serratus Anterior Plane Block (SAPB). Results The results of our study showed that there was no statistically significant difference between groups regarding demographic data. There was a statistically significant decrease in Mean blood pressure (mmHg) in Group I compared with Group II from hour-4 to hour-16 postoperative. However, a statistically significant decrease in group I compared to group II regarding postoperative heart rate (beat/min) from hour-4 to hour-16. A statistically significant decrease in group I compared to group II regarding visual analogue score for pain from minute-30 to after 12 hrs also was found. The current study shows highly statistically significant difference between groups as regard the need to intraoperative fentanyl incremental doses, time of first rescue analgesia, number of patients who received postoperative pethidine and total dose of opioids during the first 24 hrs. Conclusion Our findings suggest that PECS II block is more effective regarding postoperative pain control in patients undergoing modified radical mastectomy under general anesthesia compared to SAPB especially in the first 16 hours postoperative. Also patients underwent PECS II block show less need to intraoperative fentanyl incremental doses, less need to postoperative opioids and longer duration for time of rescue analgesia compared to patients underwent SAPB.