Effect of intravenous analgesia versus intraoperative pectoral block for postoperative pain management in patients undergoing modified radical mastectomy

Abstract

Objective: To evaluate the efficacy of intravenous analgesia versus intraoperative pectoral nerve block (PECs block) for postoperative pain management in patients having modified radical mastectomy (MRM).

Methods: This randomized controlled trial was conducted at Akbar Niazi Teaching Hospital, Islamabad, from July to December 2025 (NCT07257874). PECs block (Group A, n=30) and intravenous analgesia (Group B, n=30) were the two groups into which 60 adult female patients (18–65 years) undergoing elective unilateral MRM were randomly assigned. Ten milliliters of 0.5% bupivacaine split between two fascial planes were used to administer PECs block. The Numeric Pain Rating Scale (NPRS) was used to measure postoperative pain intensity at 0, 6, 12, and 24 hours. Postoperative nausea and vomiting (PONV), time to first rescue analgesia, total opioid consumption within 24 hours, and patient satisfaction were secondary outcomes.

Results: At every time point, Group A—NPRS scores were significantly lower than Group B (0 h: 2.1±0.8 vs. 3.4±1.1; 6 h: 2.6±0.9 vs. 4.1±1.2; 12 h: 2.9±0.8 vs. 4.0±1.0; 24 h: 2.4±0.7 vs. 3.5±0.9; p<0.001). Group B consumed more opioids overall (28.7±6.2 mg) than Group A (mean 18.3±4.5 mg; p<0.001). The PECs group experienced a significantly longer time to first rescue analgesia (412±85 minutes vs. 263±74 minutes; p<0.001). PONV incidence was reduced in Group A (10%) versus Group B (33%). No block-related complications were observed. Group A had higher patient satisfaction scores (p<0.01).

Conclusion: When compared to intravenous analgesia alone, PECs block improves recovery profiles, reduces the need for opioids, and offers better postoperative analgesia in MRM patients. It ought to be incorporated into standard perioperative pain management techniques.