Effectiveness of Ultrasonography Guided Pectoral Nerve Block and Paravertebral Block For Post-Operative Analgesia in Modified Radical Mastectomy

Abstract

Background: Incomplete alleviation of postoperative pain in modified radical mastectomy surgery causes significant morbidity and patient dissatisfaction. General anaesthesia with postoperative NSAIDs and opioids commonly used technique for postoperative analgesia after breast surgeries. Along with regional anaesthesia various peripheral nerve blocks are performed to manage this problem. Paravertebral block and pectoral nerve block are exercised widely to reduce postoperative pain after modified radical mastectomy.
Objective: The aim of this study is to assess the effectiveness of ultrasonography guided paravertebral block and pectoral nerve block for postoperative analgesia for modified radical mastectomy.
Methods: This randomized control trial was conducted at Dhaka Medical College & Hospital, Dhaka from July 2020 to June 2021. Total 60 patients, scheduled for modified radical mastectomy and randomly divided into two groups having 30 patients in each (Group-A= paravertebral block and Group-B =pectoral nerve block). Among them, 5 patients were excluded from the study due to block failure (three in group A and two in group B). So, finally, data were calculated for the 55 patients (27 patients in group A and 28 in group B). Heart rate, systolic blood pressure, mean arterial pressure, the time of first analgesic demand and the total amount of analgesic consumption in the first 24 hours by VAS were recorded and compared between two groups during postoperative period. Statistical analysis was done by SPSS version 25. Chi-square test was done for qualitative variables and Student’s t-test was done for quantitative variables. P < 0.05 was considered statistically significant.
Results: The demographic profile were well matched between two groups (P > 0.05). The mean VAS score was significantly lower in pectoral nerve block as compared to the paravertebral block at all-time intervals except at 12 hours and 20 hours (P < 0.05). Patients with pectoral nerve block had significantly late 1st analgesic demand (12.2 ± 2.1 hours’ vs 8.3 ± 1.8 hours) (P < 0.05) and significantly less total opioid consumption (165.7 ± 18.2mg vs 255.6 ± 15.8mg) (P < 0.05) compared to patients with paravertebral block. Post-operative side effects were noted significantly more in patients with paravertebral block compared to pectoral nerve block.
Conclusion: Pectoral nerve block performed in patients scheduled for modified radical mastectomy results in better pain control, late first analgesic demand and less postoperative opioid consumption in the first 24 hours than paravertebral block.