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Background and Aims The aim was measure the efficacy of intraoperative musculofascial plane infiltration with Ropivacaine during breast surgery in providing postoperative analgesia, 24 hour opioid consumption and detecting the ancillary incidence of postoperative nausea vomiting during the initial 24hours of the postoperative period.

Methods In the study group (48patients), after removal of breast tissue/tumor, the plane of infiltration was identified under direct vision by the surgeon. 30ml of Ropivacaine (0.375%) was infiltrated at 3 points, 10ml in each plane. At PEC1, between pectoralis major and pectoralis minor muscle. At PEC 2, between pectoralis minor and serratus anterior muscle and at serratus anterior plane under direct vision with a 22gauge, 2.5inch intravenous needle. In the control group (48patients) no local anaesthetic was infiltrated. Patients from both groups received the same intravenous anaesthetic agents and muscle relaxants. Patients in both groups received IV Paracetamol and ketorolac in the intraoperative period. Ondansetron was administered prophylactically in both groups to manage postoperative nausea and vomiting. Pain was assessed by the Numerical rating Scale (NRS) at regular intervals in the postoperative period. Tramadol was administered for breakthrough pain.

Results Pain control was superior in the study group. Tramadol consumption was lower in the study group. The incidence of postoperative nausea and vomiting was lower in the study group.

Conclusions Three level myofascial plane block is safe, effective, reliable, easy to perform in decreasing opioid consumption, improving postoperative pain control, providing patient satisfaction after breast cancer surgery.