Ultrasound guided pectoral nerve block with or without ultrasound guided transversus thoracic plane block in modified radical mastectomy; a randomized controlled trial

Background & objective: For managing acute postoperative pain is multimodal analgesia, including regional blocks. None of the regional techniques can block the whole breast innervation. Combining different blocks may address the inadequacy of existing methods. This study compared the perioperative analgesic efficacy of US-guided transversus thoracis muscle plane block (TTPB) combined with pectoralis nerve (PECS II) block versus PECS II block alone in patients subjected to modified radical mastectomy (MRM). Methodology: This prospective randomized clinical trial involved 34 female patients scheduled for MRM under general anesthesia (GA). Patients were randomized into two equal groups: Combined Group (n=17) received TTPB and PECS II block, and PECS Group (n=17) received PECS II block 30 minutes before inducing GA. The primary outcome measure was the total postoperative opioid requirements. Secondary outcomes were postoperative pain, duration of analgesia, hemodynamic stability, and sedation. Results: The total postoperative morphine consumption was significantly lower (P < 0.001), the duration of analgesia was significantly longer (P < 0.001), and the sedation score was significantly higher (P = 0.034) in the combined group than in the PECS Group . The pain scores were significantly lower in the combined group between 2 and 12 h. Both techniques showed hemodynamic stability, with lower heart rate and blood pressure in the combined group. Conclusion: Adding TTPB to the PECS II block was superior to the PECS II block alone for patients undergoing MRM. The combined block reduced postoperative pain and morphine consumption. The patients were more well-sedated with improved hemodynamics. Abbreviations: GA: general anesthesia, MRM: modified radical mastectomy, PECS II block: pectoralis nerve block, TTPB: transversus thoracis muscle plane block. Keywords: Ultrasound; Transversus Thoracic; Pectoral Nerve Block; Modified Radical Mastectomy; Analgesia Citation: Abed SM, Soliman AM, Elrawas MM, Elsheikh SAE, Abdallah AA, Tabashy RH, Kamel MA. Ultrasound guided pectoral nerve block with or without ultrasound guided transversus thoracic plane block in modified radical mastectomy; a randomized controlled trial. Anaesth. pain intensive care 2025;29(2):170-176. DOI: 10.35975/apic.v29i2.2700 Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025