Beyond Acute Analgesia: Evaluating the Role of PECS Block with Dexamethasone in Transitional Pain Services and Chronic Postmastectomy Pain Prevention

Abstract Background and Aim: Pectoral nerve blocks have emerged as a promising technique for postoperative pain management following breast surgery. The addition of dexamethasone to local anesthetics has been shown to prolong the duration of nerve blocks, enhancing analgesic efficacy. This study investigates the efficacy of PECS-1 and PECS-2 blocks with dexamethasone for postoperative pain management and preventing chronic postmastectomy pain (CPM) syndrome. We evaluated time to first rescue analgesia, pain intensity (Numerical Rating Scale), analgesic consumption, and adverse effects. The findings may provide valuable insights into optimizing pain management strategies for breast surgery patients. Materials and Methods: This prospective, double-blind, randomized trial included 60 patients undergoing elective modified radical mastectomy (MRM). The participants were randomly allocated to one of two groups: Group B – patients in this group received an ultrasound-guided PECS block with 0.25% bupivacaine (28 mL) combined with 2 mL of saline. Group BD: Patients in this group received an ultrasound-guided PECS block with 0.25% bupivacaine (28 mL) combined with dexamethasone 8 mg (2 mL). Results: Group BD exhibited a statistically significant reduction in 24-h analgesic consumption compared to Group B ( P < 0.001). The duration to first rescue analgesia was notably longer in Group BD (462.33 ± 22.23 min) versus Group B (378.67 ± 50.36 min), with P < 0.001. Group BD demonstrated significantly lower Numeric Rating Scale compared to Group B ( P < 0.001). Adverse effects were comparable across the study groups. Conclusion: This study concludes that PECS blocks with bupivacaine and dexamethasone provide effective postoperative pain relief, reduce opioid use, and prolong pain relief duration in breast cancer surgery patients. By minimizing intense pain, this approach may reduce the risk of CPM syndrome, improving patient outcomes. Integrating PECS blocks with dexamethasone into perioperative care may enhance patient care and reduce long-term pain risks.