Analgesic Efficacy of Ultrasound Guided Serratus Anterior Plane Block and Pectoral Nerve Block II compared to Thoracic Epidural Block after Unilateral Modified Radical Mastectomy

Ahmed, Alaa Aldine Mahmoud Said; Aboelsuod, Mohamed Abdelgawad Abdelhalim; Amer, Ahmed El Basuni Ali

doi:10.21608/aimj.2025.446527

Analgesic Efficacy of Ultrasound Guided Serratus Anterior Plane Block and Pectoral Nerve Block II compared to Thoracic Epidural Block after Unilateral Modified Radical Mastectomy

Document Type : Original Article

Authors

Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

10.21608/aimj.2025.446527

Abstract

Background: The gold standard surgical treatment for breast cancer is a modified radical mastectomy, which makes up 31% of all breast surgeries. In the immediate aftermath of surgery, 40-60% of patients report significant discomfort. Symptoms such as complex regional pain syndrome (causalgia) and post-mastectomy pain syndrome (PMPS) may develop after 6-12 months of this type of discomfort.
Aim and objectives: Examining the effectiveness of three different blocks in managing postoperative pain after a modified radical mastectomy: thoracic epidural, ultrasound-guided PECS II, and ultrasound-guided serratus anterior plane.
Patients and methods: Taking place from February 2023 through January 2025 at Al-Azhar University Hospitals, this prospective randomized double-blind clinical trial had 99 patients scheduled for unilateral modified radical mastectomy. Three groups were formed from the patients at random.
Results: Time to first rescue analgesia for the pectoral nerve block (PECS) group was significantly longer in the serratus anterior plane block (SAPB) group compared to the Thoracic epidural (TEB) and PECS groups. The SAPB group drank a lot more morphine than either the TEB or PECS groups, whereas the TEB group drank much less than the PECS group. All three groups had similarly delayed block onset.
Conclusion: The PECS block demonstrated superior efficacy for post-mastectomy pain management, with optimal hemodynamic stability, better pain control, a decrease in opioid usage, and a lengthened duration before the onset of rescue analgesia, while SAPB showed inferior outcomes with higher pain scores, increased opioid requirements, and poor hemodynamic control, making PECS the preferred choice for modified radical mastectomy procedures.

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