Ultrasound Guided PECS II Block versus Thoracic Epidural in Modified Radical Mastectomy for Post-Operative Pain Relief

Abstract
Background: Breast cancer is women's most common malignancy and has steadily increased incidence over the past decade. Despite recent breast cancer surgery advances, this procedure is often associated with postoperative pain, nausea, and vomiting, contributing not only to increased patient discomfort, but also to extended hospital stays and associated costs. A significant risk factor for the development of chronic pain following breast surgery is acute postoperative pain due to insufficient or ineffective pain control.
Aim of Study: Assess the effectiveness of ultrasound guided PECS block to thoracic epidural blockage in breast cancer surgery to minimize postoperative pain, analgesic requirements and complications.
Patients and Methods: After Ethical Committee at Al-Zahraa University Hospital accepted, 50 female patients, age from 42-67 years, were included in the study with ASA physical status I-II patients scheduled for unilateral modified radical mastectomy and axillary lymph node dissection, randomly blind assigned, split two different groups of 25 patients in each, Thoracic epidural block (TEB group); patients were received a single shot of 15ml of 0.25% bupivacaine between T4 and T5 vertebrae. PECS group: Ultrasound-guided PECS block, the patients were received 0.25% of 10ml bupi-vacaine injected at fiscal plain between the pectoral s major and minor muscles (PECS I) also 0.25% of 20ml of pectoral-minor injection above the Serratus anterior muscle (PECS II). Primary outcome in the form of post-operative visual analogue scale (VAS) to assess pain in density. Secondary outcome in the form heart rate (HR), mean blood pressure (MBP) intra operative fentanyl consumption and, first request of analgesia, total amount of pethidine/24 hrs. were recorded and other any post-operative complication were assessed.
Results: The patients of TEB group, the mean heart rate and the mean MAP were highly significant decrease than PECS group. Intra operative fentanyl consumption as statis-tically significant decrease in PECS group compared with TEB group. VAS pain scores was high statistically significant decrease immediately and at 4 hrs. post-operative in PECS group than TEB group. The time for the first request for pethidine was highly significantly longer in the PECS group than in TEB group. Amount of pethidine at 24 hrs. was high significant lower in PECS group in comparison with TEB group. Complications recorded as hypotension and bradycardia post-operative nausea and vomiting (PONV) occurrence in TEB group.
Conclusion: PECS blocks provided superior post-operative analgesia, low pain scores and less total pethidine consumption in the early postoperative period and maintained hemodynamic stability compared to TEB.