Comparison Of Efficacy Of Ultrasound Guided Single Level Thoracic Paravertebral Block VersusComplete Antethoracic Block For Postoperative Analgesia In Modified Radical Mastectomy:A Non Inferiority Randomized Controlled Trial

Breast cancer is increasingly becoming the most common cancer among females worldwide.Modified radical mastectomy(MRM) is a common surgical procedure being performed for patients with breast cancer.Perioperative pain management is one of the crucial elements required for optimal outcome of patients undergoing oncosurgical procedures.The optimal use of analgesic technique provides both short term benefits like adequate pain management,reduced postoperative nausea and vomiting,improved quality of surgical recovery and long term benefits like reduced risk of development of chronic postsurgical pain and development of metastases and recurrent disease.A number of regional anesthetic techniques like local wound infiltration,thoracic epidural anesthesia and thoracic paravertebral block and more recently fascial blocks have been employed for perioperative pain in patients undergoing breast cancer surgeries.The fascial blocks include classical and modified Pectoralis nerve block(PECS),Serratus anterior plane(SAP) and Erector spinae plane block(ESPB).The pectoral nerve block is an easy and safe nerve block for breast surgery.But it does not sufficiently block the anterior branches of the intercostal nerves (from T2 to T6) or the lateral branches of the intercostal nerves (from T5 to T6); therefore, postoperative analgesia of the internal and inferior mammary area may be insufficient. Complete Antethoracic block blocks these spared anterior and lateral branches of intercostal nerves too,hence better analgesia of the breast is provided.There is a case report on analgesic effect of complete antethoracic block,but it has not been compared with paravertebral block to compare its analgesic efficacy previously.Hence,with the above background, we planned a prospective randomized clinical trial to compare the analgesic efficacy of single level thoracic paravertebral block and complete antethoracic block in patients undergoing modified radical mastectomy.