Single Shot Pectoral Plane Block Type 2 (PECS II) Versus Serratus Anterior Plane Block for Postoperative Analgesia Following Modified Radical Mastectomy for Postoperative Acute and Long-Term Pain: A Randomized Clinical Trial

Aparna Bagle; Yashwant Nankar; Kshitija  Devendra Bora

doi:10.18502/aacc.v12i3.21312

Aparna Bagle Department of Anaesthesiology, D.Y. Patil Medical College, Hospital & Research Centre, Pune, India.
Yashwant Nankar Department of Anaesthesiology, D.Y. Patil Medical College, Hospital & Research Centre, Pune, India.
Kshitija Devendra Bora Department of Anaesthesiology, D.Y. Patil Medical College, Hospital & Research Centre, Pune, India.

DOI: https://doi.org/10.18502/aacc.v12i3.21312

Keywords: Pectoral nerve block (PECS II); Serratus anterior plane block (SAPB); Postoperative pain; Modified radical mastectomy (MRM); Post-mastectomy pain syndrome (PMPS); Regional anesthesia

Abstract

Background: Effective management of postoperative pain in breast cancer surgery is crucial to enhance recovery and quality of life. Regional anesthesia techniques such as Pecs II and Serratus Anterior Plane Block (SAPB) have emerged as alternatives to systemic opioids. To compare the efficacy of single-shot Pecs II block and SAPB in terms of acute and long-term (up-to 2 months) postoperative analgesia following modified radical mastectomy.

Methods: A single-blind, randomized controlled trial was conducted on 46 ASA I-II female patients undergoing MRM, assigned to either Pecs II block (Group P) or SAPB (Group S), each with 30 mL of 0.25% bupivacaine. Numerical Rating Scale (NRS) scores at rest and during movement were recorded perioperatively and during 60-day follow-up. Secondary outcomes included time to first rescue analgesia, number of rescue analgesics in 48 hours, and adverse effects.

Results: Both blocks provided comparable acute pain relief in the first 48 hours (p>0.05). Group P showed significantly lower NRS scores at 15, 30, and 60 days at rest and on movement (p<0.05), indicating better long-term analgesia. There was no significant difference in rescue analgesic requirements or adverse effects.

Conclusion: Both Pecs II and SAPB offer effective acute postoperative pain control following MRM, while Pecs II provides superior long-term analgesia.