Ultrasound guided paravertebral block vs. modified PECS block for modified radical mastectomy

Abstract

Aim & objectives: To compare safety and efficacy of ultrasound guided modified pectoral nerve block (PECS block) and paravertebral (PVB) block in patients undergoing modified radical mastectomy.
Methodology: In this prospective, randomized, single blind study, sixty ASA class I-II patients posted for modified radical mastectomy were randomly allocated one of the two groups; Group 1 and Group 2 each with thirty patients. Both the groups received ultrasound guided blocks. Patients of Group 1 received PVB and Group 2 received PECS block.
Results: Both the groups were comparable with respect to initial characteristics like age, weight, height, BMI, ASA class. Intraoperatively both the blocks were comparable in consumption of fentanyl use. Postoperatively PVB group received more tramadol (rescue analgesic) in comparison to Modifies PECS block group. Postoperatively PVB group received more ondansetron compare to Modified PECS block in initial 12 h. At 24h postoperatively both the groups were comparable in total tramadol and ondansetron used. Both the blocks were comparable in terms of VAS score at rest and VAS score during physiotherapy at 24 h. Episodes of hypotension were more with PVB as it also causes sympathetic block.
Conclusion Ultrasound guidance has brought a revolution in the field of nerve blocks because it is now possible to directly visualise the muscular planes, the advancing needle and the spread of local anesthetic solution during injection in real time. With our experience we suggest Modified PECS block better alternative in breast surgeries. Larger RCTs are required to establish the fact.
Citation: Joshi R, Singh MK, Bhattacharjee S, Tobin R, Kaur D, Singh SK. Ultrasound guided paravertebral block vs. modified PECS block for modified radical mastectomy. Anaesth. pain & intensive care 2019;23(2):172-177