Background and Aims TPVB is considered the gold standard for breast surgery but is associated with complications. Though PEC block has been used with good results, it spares the medial part of the breast. PIFB targets the anterior cutaneous branch of the intercostal nerve, which supplies the medial aspect of breast. We hypothesised that USG guided combined pectoral nerve block and pecto intercostal fascial block will provide better perioperative analgesia and less adverse effects in MRM patients as compared to paravertebral block.

Methods 30 ASAI and II patients posted for MRM under general anaesthesia were included in this double blinded RCT. Patients in Group A received US guided TPVB, whereas Group B received a combined PEC with PICF block. Post-operatively patients were administered intravenous morphine via patient- controlled analgesia (PCA) pump. Time to first rescue analgesia, total opioid consumption, NRS at various time intervals, Total rescue dose required, Patient satisfaction score were noted.

Results There was no difference in intraoperative opioid consumption. The time to first rescue analgesia was more in TPVB group (GA 673 min +/- 496) than PEC-PICF group. (GB 518 min +/-413). P value:0.18. The 24-hour opioid consumption (162+/-41.7mcg Vs 149+/-44.5mcg), median NRS scores (GA Rest2/Motion2 Vs GB Rest2/Motion3) and patient satisfaction (GA 2.6 vs GB 2.8) was similar in both the groups. There was no adverse effects in wither groups. (vascular puncture, pneumothorax, vomiting).

Conclusions PECS block provides similar analgesia in terms of 24 hours opioid consumption, NRS scores and PSS in MRM patients. Further increase in sample size will validate our results.