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

Abstract

Objective: To compare the effectiveness of intraoperatively performed PECS block (without the ultrasound guidance) and no regional blocks in controlling postoperative pain and opioid use among patients undergoing elective modified radical mastectomy (MRM) and Mastectomy.
Methodology: Study Design: Randomised controlled trial.
Duration and Place of Study: This study was conducted from Oct 2024 to march 2025 in Pakistan Institute of Medical Sciences, Islamabad. A randomized, controlled prospective study will be a study of 60 female (ASA I- II) patients who are to undergo MRM and Mastectomy. The patients were randomized into two groups, Group P (PEC group): Received PECS block intraoperatively under direct
view (surgeon assisted) and Group C (Control group): Received standard general anesthesia without block. Primary outcome: Requirement of Analgesia. Secondary outcomes: Total Opioid use in 24 hours, Mean time to first rescue analgesic request,Visual Analogue Scale (VAS).
Results : The average time to first rescue analgesia was similar between the PECS block group
and control group (70.04 + 44.01 vs. 54.44 + 31.01 minutes; p =0.118). There was no
significant difference in the total intraoperative tramadol intake (104.14 ± 15.02 mg vs.
96.82 ± 30.62 mg; p = 0.244). The Tramadol requirement postoperative rescue
analgesia and the percentage of the patients rescued by the analgesia remained similar in the groups (p > 0.05). The mean VAS pain scores of the two groups in all the time points assessed (1, 2, 4, 6, 12, and 24 hours after the operations) were significantly lower and no differing VAS pain scores between the two groups were found to be statistically significant.
Conclusion: PECS block, when used intraoperatively, is safe and effective as a supplement to
general anesthesia among patients that undergo elective modified radical mastectomy.
It was proven to be more effective in terms of postoperative pain scores measured with
the Visual Analog Scale (VAS) at pre-specified postoperative intervals and cumulative
opioid consumption at 24 hours post operation significantly reduced compared to
patients who received no block. Safety was measured using the incidences of
perioperative and postoperative complications associated with the block and no adverse
events associated with the blocks. It was also related to the decreased incidence of
opioid-related adverse effects when PECS block was used, which contributes to the
effectiveness of multimodal analgesia with PECS block in breast cancer surgery.