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Abstract
Background and Aims Breast cancer accounts for 25–32% of all female cancers in India1. Modified radical mastectomy (MRM), a common surgical procedure, comprises 31% of all breast surgeries performed2. A postoperative plan incorporating regional nerve blocks provide efficient analgesia, early mobilization, recovery, and prevention of chronic pain3.
This study aims to compare the efficacy and safety of modified pectoral nerve (PECS) block and Erector Spinae Plane (ESP) block for pain management in patients undergoing MRM.
Methods This study was registered with the Clinical Trials Registry of India (CTRI/2019/06/019656) following approval from Max Healthcare Ethics Committee.
80 adult female patients (ASA grades I&II) undergoing modified radical mastectomy were randomly allocated into two groups to receive PECS block and ESP block with 30 ml of 0.375% Levobupivacaine, after induction of anaesthesia. Fentanyl was administered for postoperative pain relief via PCA pump.
Outcomes such as Numerical Rating Scale (NRS) scores to assess pain, time to first rescue analgesia, intraoperative and postoperative fentanyl requirement, incidence of PONV, patient satisfaction etc. were statistically analysed.
Results Patients given modified PECS block experienced significantly better quality of analgesia and perceived the block to be more satisfactory with respect to pain relief and ability to sleep (p < 0.001). With PECS block, patients showed significantly lower mean NRS scores at 24-hours postoperatively (1.18 ±1.13 vs 2.65 ±0.98)(p<0.001) and total fentanyl consumed was considerably lesser (61.25 ± 41.58 mcg vs 183.75 ± 51.13 mcg)(p<0.001).
Conclusions We found that modified PECS block provided superior postoperative analgesia than ESP block in patients undergoing MRM without any adverse effects.