Analgesic Effect of Conventional Paravertebral versus Mid transverse Process to Pleura Blocks on Post Mastectomy Pain in Unilateral Modified Radical Mastectomy Surgeries

Background: Moderately severe postoperative pain is linked to modified radical mastectomy (MRM). Acute postmastectomy pain can be effectively relieved by regional nerve block, which also lessens the frequency and intensity of chronic pain. Even though thoracic paravertebral block (TPVB) uses ultrasound, there is still a need to find a safer method. An additional localized method for postoperative analgesia is mid-transverse process to pleura block (MTPB). So, we aimed to evaluate analgesic effects of pleura blocks vs traditional paravertebral and mid-transverse process blocks in unilateral modified radical mastectomy procedures. Methods: Hundred females who underwent modified radical mastectomy were randomized to receive either preoperative TPVB (group C), or MTPB (group M), both performed at (T3-T4) with 20 ml of bupivacaine 0.25%. The primary outcome was visual analogue pain score (VAS) in the post anesthesia care unit (PACU). The secondary outcome was onset and duration of the block, Total postoperative opioid consumption, time to first rescue analgesia and patients satisfaction for 24 hours after surgery, then incidence of chronic pain after one and 6 months of surgery were recorded.Results: There was significant difference between two groups regarding pain score with lower VAS, rapid onset, higher dermatomal level in TPVB group. While the intraoperative fentanyl consumption, postoperative pethidine consumption, time to first rescue analgesia, duration of the block, incidence of chronic pain, patient satisfaction were comparable between two groups. Conclusion: MTPB and demonstrates good postoperative analgesia in MRM surgery with better pain scores, higher dermatomal level and faster onset of block in PVB.