Combined PECS II and Transversus Plane Blocks Versus Erector Spinae Block in Modified Radical Mastectomy

Assiut University

Status: Completed

Conditions: Breast Cancer; Acute Postoperative Pain

Treatments: Procedure: Combined Modified Pectoralis and Transversus Plane Blocks; Procedure: Erector Spinae block

Study type: Interventional

Funder types: Other

Identifiers

NCT03903224

Analgesia in breast surgey

Details and patient eligibility

About

The aim of this study is to compare the total morphine consumption in the first 24 hour postoperative between combined modified pectoralis block (PECS II) and transversus plane block versus erector spinae block in modified radical mastectomy.

Full description

Breast cancer is the most common malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. Breast surgery is commonly performed as a part of the management of breast cancer, is associated with considerable acute postoperative pain. Ultrasound guided Regional anesthesia is recommended to be a part of multimodal analgesia in order to manage the acute post-operative pain. New techniques are proposed to give adequate control of postoperative analgesia with less opioid needs in the first day postoperative. They include pectoralis nerve modified pectoralis, and erector spinae blocks.

The investigators will compare Modified pectoralis nerve block (Pecs II) plus transversus thoracic muscle plane (TTP) block versus Erector spinae block on morphine consumption during first 24 h following modified radical mastectomy.

Enrollment: 60 patients

Sex: Female

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18: 60 years old
• ASA (American Society of Anesthesiologists) physical status I II
• Female patients scheduled for modified radical mastectomy

Exclusion criteria

• Patient refusal or inability to give informed consent
• Subjects with a medical contraindication to regional anesthesia , such as coagulopathy, local infection or an allergy to local anesthetic
• Body mass index (BMI) >35
• Presence of psychiatric diseases
• History of chronic chest wall pain or neuropathic disorders
• Alcohol or drug abuse
• Severe chest wall deformities

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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60 participants in 2 patient groups

Combined PECS II and TTP blocks (PT)

Active Comparator group

Description:

Modified Pectoralis block (PECS II) : Using ultrasound we proceed to inject 10 ml of bupivacaine 0.25% between the pectoral muscles and 10 ml under Pmm above the serratus muscle. Transversus Thoracic Plane block : 10 mL bupivacaine (0.25%) is injected between the transversus thoracic muscle and the internal intercostal muscle between the third and fourth left ribs connecting at the sternum.

Treatment:

Procedure: Combined Modified Pectoralis and Transversus Plane Blocks

Erector Spinae Block (E)

Active Comparator group

Description:

Using ultrasound an echogenic 22-G block needle is inserted in-plane in a cranial-to-caudal direction until contact is made with the T5 transverse process. A total of 30 bupivacaine 0.25% is then injected while seeing the fluid lifting the erector spinae muscle off.

Treatment:

Procedure: Erector Spinae block