Efficacy of PECS Block In Perioperative Period For Pain Management In Patients Undergoing Elective Breast Surgery

Abstract

Objective: To evaluate the effectiveness of intraoperatively performed, non-ultrasound-guided pectoral nerve (PECS) block compared to no regional block in controlling postoperative pain and opioid consumption in patients undergoing elective breast surgery.

Methodology: This randomized controlled trial was conducted from October 2024 to March 2025 at Pakistan Institute of Medical Sciences, Islamabad. Sixty female patients (ASA I–III) scheduled for modified radical mastectomy or simple mastectomy were randomly allocated into two groups: Group P (PECS block under direct vision) and Group C (control, no block). The primary outcome was postoperative analgesic requirement. Secondary outcomes included total opioid consumption within 24 hours, time to first rescue analgesia, and Visual Analogue Scale (VAS) pain scores.

Results: The mean time to first rescue analgesia was longer in the PECS group but not statistically significant (70.04 ± 44.01 vs. 54.44 ± 31.01 minutes; p = 0.118). Intraoperative and postoperative tramadol consumption was comparable between groups (p > 0.05). The proportion of patients requiring rescue analgesia was also similar. VAS pain scores at 1, 2, 4, 6, 12, and 24 hours postoperatively showed no statistically significant differences between groups, although consistently lower trends were observed in the PECS group.

Conclusion: Non-ultrasound-guided PECS block is a safe and feasible adjunct to general anesthesia but did not demonstrate statistically significant improvement in postoperative pain control or opioid consumption. However, modest clinical benefits suggest potential utility in resource-limited settings. Larger studies with ultrasound guidance are recommended to better define its efficacy.