Breast cancer ranks first among the most common malignant neoplasms in women. Surgery has
been a mainstay of breast cancer treatment for several decades and historically, a
modified radical mastectomy was the primary method of treatment for breast cancer. Poorly
controlled acute postoperative pain is associated with increased morbidity, functional
and quality-of-life impairment. Additionally, severe acute postoperative pain is found to
be a risk factor for chronic pain.
Thoracic paravertebral, thoracic epidural, intercostal nerve, and interscalene brachial
plexus blocks have been used for anesthesia and abirritation during modified radical
mastectomy, but their application is limited due to the complex nature of the procedures
and serious complications. There is growing interest in the pectoralis nerve (PECS)
blocks and serratus anterior block (SAB) which are less invasive as an analgesic
technique during breast surgeries to reduce postoperative pain.
The Pecs I block is a single injection of local anaesthetic between pectoralis major and
pectoralis minor muscles at the level of the 3rd rib to anaesthetise the lateral and
medial pectoral nerves. The Pecs II block is a modified Pecs I block and can be achieved
with one needle insertion point. Local anaesthetic is placed between pectorals major and
minor as for a Pecs I block and then between pectoralis minor and serratus anterior
muscles.
Numerous clinical studies focusing on the analgesic potential of PECS block in breast
augmentation surgery, small breast surgery and breast cancer surgery have yielded
positive results. SAD is more superficial, easy to access and less likely to have
complications like PECS block. SAPB can be implemented in two ways. Deep SAB (DSAB) is
applied under the serratus anterior muscle, while superficial SAB (YSAB) is applied over
the serratus anterior muscle. In recent years, deep and superficial SAB, that is,
combined SAB (CSAB), has been started to be applied in order to increase the effect area
of local anesthetics and to prevent block failure.
In this study, PECS II block or CSAB will be applied to patients who have had a modified
radical mastectomy under general anesthesia for postoperative pain relief by using 30 ml
of 0.25% bupivacaine .All patients will receive tramadol with a patient-controlled
analgesia device during the postoperative period. Pain, nausea-vomiting, additional
analgesic and antiemetic drug requirement, within 24 hours postoperatively will be
compared between groups.
In this study, it was aimed to compare the efficacy of both peripheral nerve block
methods in patients after mastectomy.