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.

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

Breast Cancer

Acute Postoperative Pain

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.

Combined Modified Pectoralis and Transversus Plane Blocks

Erector Spinae block

Effect of Combined Modified Pectoralis and Transversus Plane Blocks Versus Erector Spinae Block on Postoperative Analgesia Following Modified Radical Mastectomy

Professor doctor of anaesthesia and ICU Faculty of Medicine - Assiut University

Verbal numeric rating scale (VNRS) for postoperative pain monitoring using 11-point where
zero equals no pain and 10 equals the worst pain imaginable.

Time from postoperative period to time of first analgesic request in minutes

Preoperative baseline and postoperative levels of IL6 will be measured (pg/mL)

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.

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.

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

About this trial

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Placebo

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