COMPARISON OF THE EFFICACY OF ULTRASOUND GUIDED ERECTOR SPINAE PLANE BLOCK, PECTORAL NERVE BLOCK AND THORACIC EPIDURAL FOR POSTOPERATIVE ANALGESIA AFTER MASTECTOMY SURGERY RANDOMIZED COMPARATIVE PROSPECTIVE CLINICAL STUDY

Abstract

Background: Breast cancer operation is one of the most prevalent surgical procedures for females, with approximately 50% of cases having persistent pain (Postmastectomy Pain Syndrome) postoperatively, with twenty-four percent of these cases reporting their pain as moderate to severe. Evidence-based recommendations for the use of multimodal analgesia to treat postoperative pain were approved by the American Society of Anesthesiologists

Objective: Compare analgesic effectiveness of US guided PECSII with ESP block & TE for post operative analgesia.

Patients & Methods: This randomized comparative prospective clinical trial was conducted at Al-Zahraa University Hospital, Cairo, and Sharq Elmadina Hospital, Alexandria. 105 females between the ages of 40 and 60, with ASA II or III and a BMI less than 30, were enrolled. females were divided into three groups at random (35 female/each): ES, PECSII(PE) or TE.

Results: Time to perform block was longest in TE Group, VAS was lower in PECSII and ES Groups compared to TE Group at various postoperative intervals. Analgesic consumption was also reduced in the PECSII and ES groups. Intraoperative hemodynamics were lowest in TE Group in the first 6 hours then increased. Patient satisfaction scores were highest with the PECSII Group, followed closely by ES Group. Stress markers were highest in group TE.

Conclusion: The US guided single-shot PECSII offers superior analgesic efficacy, patient satisfaction, and safety compared to TE Analgesia and ES block for postoperative pain management following simple mastectomy. PECSII showed shorter block performance time, lower pain scores, delayed first morphine request time, and reduced total 24-hour analgesic consumption compared to TE and ES.