COMPARING THE QUALITY OF ANALGESIA WITH ULTRASOUND-GUIDED PECTORAL NERVE BLOCK AND SERRATUS ANTERIOR PLANE BLOCK II IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY: A RANDOMIZED CLINICAL TRIAL
Keywords:
Modified radical mastectomy, PECS II block, Serratus anterior plane block II, Ultrasound-guided regional anaesthesia, Postoperative analgesia, Breast surgery, Visual Analogue Scale, Opioid-sparing analgesia, Randomized controlled trialAbstract
Background: Modified radical mastectomy (MRM) remains one of the most commonly performed procedures for breast cancer. Despite advances in perioperative care, postoperative pain continues to be a major concern owing to extensive surgical dissection involving the breast, pectoral muscles, axilla, and intercostobrachial nerves. Inadequate analgesia delays recovery, increases opioid consumption, prolongs hospital stay, and may contribute to chronic post-mastectomy pain syndrome. Ultrasound-guided fascial plane blocks, particularly the Pectoral Nerve Block (PECS II) and Serratus Anterior Plane Block II (SAP II), have emerged as effective components of multimodal analgesia. However, evidence directly comparing their analgesic efficacy remains limited. Aim: To compare the efficacy of ultrasound-guided PECS II block and Serratus Anterior Plane Block II in providing postoperative analgesia for patients undergoing modified radical mastectomy under general anaesthesia.
Methods: This prospective, randomized, parallel-group controlled trial will be conducted in the Department of Anaesthesiology at a tertiary care teaching hospital. Eighty adult female patients aged 18–70 years with ASA physical status I–III scheduled for elective modified radical mastectomy will be randomly allocated into two groups: Group P (ultrasound-guided PECS II block) and Group S (ultrasound-guided Serratus Anterior Plane Block II). The primary outcome will be postoperative pain assessed using the Visual Analogue Scale (VAS) during the first 24 postoperative hours. Secondary outcomes will include time to first rescue analgesia, total postoperative analgesic consumption, opioid requirement, patient satisfaction, and block-related complications.
Results: Both regional techniques are expected to provide effective postoperative analgesia. However, ultrasound-guided PECS II block is anticipated to produce lower postoperative pain scores, prolong analgesia, reduce postoperative opioid consumption and rescue analgesic requirements, and improve patient satisfaction compared with Serratus Anterior Plane Block II, while maintaining a comparable safety profile.
Conclusion: Ultrasound-guided fascial plane blocks are effective opioid-sparing techniques for breast surgery. This study aims to provide comparative evidence regarding PECS II and Serratus Anterior Plane Block II, thereby assisting anaesthesiologists in selecting the most effective regional analgesic technique for patients undergoing modified radical mastectomy
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