Comparing the quality of post operative analgesia between ultrasound guided serratus anterior plane block and pectoral nerve block in female patients undergoing breast cancer surgery - a prospective randomised single blinded study

Breast cancer ranks first among the most common malignant neoplasms in

women. Breast cancer surgery procedures are characterized by moderate and

severe pain. Acute postoperative pain is reported in around 40% of breast cancer

patients, indicating that post operative pain treatment is insufficient. In addition,

acute postoperative pain could reduce the quality of life by increasing

the probability of post mastectomy pain syndrome. Insufficient postoperative

acute pain control is associated with increased morbidity, delayed wound healing,

lengthened hospital stay, increased side effects secondary to opioid use, chronic

pain, and high care costs. Postoperative chronic pain and long-term opioid

addiction risks after breast cancer surgery are reported to be 29 % and 11 %,

respectively.

Regional anaesthesia has an important role in the multimodal analgesia regimen

following breast surgery. The paravertebral block is considered the traditional

regional anaesthetic procedure of choice for postmastectomy pain and has shown

its ability to reduce postoperative pain scores, opioid consumption, and the

severity of chronic pain compared to general anaesthesia alone. However, this

block is also associated with negative effects and complications such as

hypotension, unintentional epidural injection, and difficulties with optimal

placement of block. In the last decade, various ultrasound (US) guided thoracic

wall blocks [pectoralis (PECS I, PECS II) nerve block, modified PECS II block,

serratus anterior plane (SAP) block] have been developed to provide reliable

analgesia in patients undergoing breast cancer surgery. The emergence of

fascial plane blocks has provided a simple, easy-to-learn alternative that lacks

many of the side effects seen with previous regional techniques used for

oncological breast procedures. In particular, the SAP and PECS blocks are

effective in breast surgery by providing analgesia to the anterior and lateral chest

walls.

In studies comparing post-mastectomy acute pain control, the thoracic

paravertebral block was outperformed by the PECS block, and the serratus anterior

plane block was reported to be less effective than the thoracic paravertebral block.

Various studies comparing PECS and SAP blocks have shown conflicting results

regarding superiority of one block over the other. Hence, this study aims to

compare the quality of post operative analgesia produced with ultrasound guided

PECS block versus the SAP block in female patients undergoing breast cancer

surgeries.