Ultrasound-Guided Modified Pectoral Plane (PECS II) Block Versus Midpoint Transverse Process to Pleura (MTP) Block for Postoperative Analgesia of Modified Radical Mastectomy
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Not specified
- Sponsor
- Ain Shams University
- Enrollment
- 88
- Locations
- 1
- Primary Endpoint
- Post-operative Pain Severity Assessed by VAS at Zero Time (on Admission to the PACU)
- Status
- Completed
- Last Updated
- 3 months ago
Overview
Brief Summary
This randomized controlled study aims to compare the analgesic efficacy of the ultrasound-guided modified pectoral nerve block (PECS II) and the midpoint transverse process to pleura (MTP) block in female patients undergoing modified radical mastectomy (MRM). Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS) over the first 24 hours, with additional evaluation of opioid consumption and complications.
Detailed Description
Modified radical mastectomy (MRM) is associated with significant postoperative pain, which may increase opioid use, delay recovery, and contribute to chronic post-mastectomy pain syndrome. This study compares two regional analgesic techniques: the ultrasound-guided modified pectoral nerve block (PECS II) and the midpoint transverse process to pleura (MTP) block. The PECS II block involves the injection of local anesthetic between the pectoralis minor and serratus anterior muscles, targeting the pectoral nerves and lateral cutaneous branches of intercostal nerves (T2-T6). It is widely used for anterior chest wall analgesia after breast surgery. The MTP block, a more recent paravertebral-domain technique, deposits anesthetic midway between the transverse process and the pleura, allowing spread to dorsal and ventral rami via the superior costotransverse ligament and potentially achieving broader thoracic segment coverage. This randomized trial evaluates postoperative pain control using the Visual Analog Scale (VAS) over 24 hours, along with opioid consumption and adverse events. The aim is to determine whether the MTP block offers superior analgesia and an opioid-sparing effect compared to the PECS II block.
Investigators
Ahmed abdelghany Khalifa ragab
lecturer of Anesthesia, intensive care and pain management
Ain Shams University
Eligibility Criteria
Inclusion Criteria
- •Female patients scheduled for modified radical mastectomy (MRM).
- •Age between 40 and 65 years.
- •American Society of Anesthesiologists (ASA) physical status I-II.
Exclusion Criteria
- •Known allergy to local anesthetics.
- •Coagulopathy.
- •Infection at the site of injection.
- •Patient refusal.
- •Inability to understand or use the pain scale.
Outcomes
Primary Outcomes
Post-operative Pain Severity Assessed by VAS at Zero Time (on Admission to the PACU)
Time Frame: will be evaluated post-operatively at zero time
Visual Analogue Scale is a scale for pain assessment ranging from 0 to 10 where 0 is minimum and means no pain while 10 is maximum and means maximum pain which means worse outcome
Secondary Outcomes
- Post-operative Pain Severity Assessed by VAS at Hour-2, Hour-4, Hour-8, Hour-12, Hour-18 and Hour-24.(24 hours postoperatively)
- Time of First Rescue Analgesia(24 hours postoperatively)
- Cumulative Post-operative Nalbuphine Consumption in the First 24 Hours(24 hours postoperatively)
- Incidence of Postoperative Side Effects and Complications(24 hours postoperatively)