Pectoral nerve block and pecto-intercostal fascial block versus thoracic paravertebral block for postoperative analgesia in modified radical mastectomy: A randomised controlled trial.

Abstract

Background and aims: Modified radical mastectomy (MRM) is associated with persistent postoperative pain. Paravertebral block (PVB) is the gold standard for postoperative analgesia. A pecto-intercostal fascial plane (PIFB) block added to the pectoral nerve block (Pecs) may provide effective analgesia. This trial aimed to compare the analgesic efficacy of Pecs-PIFB with PVB.

Methods: Fifty American Society of Anesthesiologists (ASA) I/II patients scheduled for MRM were randomly assigned to receive either Pecs-PIFB block with 30 mL for Pecs block and 15 mL for PIFB or PVB block with 20 mL (0.2% ropivacaine). Postoperatively, intravenous (IV) morphine was administered through a patient-controlled analgesia (PCA) pump. The primary outcome was to compare the time to the first demand dose of rescue analgesic. The secondary outcomes were postoperative 24-hour opioid consumption, pain scores (30 mins and 1, 2, 4, 6, 12, and 24 h), patient satisfaction score (24 h), and block-related complications. The unpaired t-test compared quantitative normally distributed data, while the Mann-Whitney U test compared quantitative discrete data. A P value < 0.05 was considered to be statistically significant.

Results: Patients in the Group Pecs-PIFB had an increased median time to first demand dose: 440 [interquartile range (IQR): 360-540] versus 340 (IQR: 180-360) minutes (P = 0.019) and lower median 24-h postoperative morphine consumption: 4 (3-6) versus 6 (4-8) mg (P = 0.020). Patients in the Group Pecs-PIFB had better pain scores at 30 minutes and 1 h.

Conclusion: Compared to thoracic PVB, the combination of Pecs and PIFB block prolonged the duration of analgesia and decreased postoperative opioid consumption in patients undergoing MRM surgeries. There was no statistical increase in complications in patients receiving this block.