Duration of Analgesia Following Postinduction Thoracic Paravertebral Block vs Pectoral Nerve Block for Modified Radical Mastectomy Under General Anesthesia

Dr Rashmi Naik, Dr Pratibha Jain Shah, Dr Neetish Kumar Budek

Abstract: Background: Modified radical mastectomy (MRM) is commonly performed under general anesthesia (GA), but inadequate postoperative pain management can lead to complications and delayed recovery. Regional anesthesia techniques, such as the thoracic paravertebral block (TPVB) and pectoral nerve block (PECB), have gained popularity for providing effective analgesia. Aim: To compare effect of postinduction TPVB and PECB for MRM under GA in terms of duration of analgesia as the primary objective and severity of pain using VAS score, patient satisfaction and side effects and complication such as hypotension, bradycardia, sedation, pneumothorax vascular puncture, PONV and hematoma as secondary objectives. Methodology: This prospective, randomized intervention study was conducted in 52 female patients scheduled for MRM under GA. Patients were randomly assigned to receive either TPVB (Group 1) or PECB (Group 2) preoperatively. Both the groups received 30 ml bupivacaine 0.25% along with dexmedetomidine 1?gm/kg. Postoperatively patient was kept in HDU. VAS was measured 2 hourly for 24 hours from the time of administration of block. Result: TPVB has longer mean duration of analgesia as compared to PEC block (1763.5?24.65 vs 1670.3?28.44 minutes) but patient?s satisfaction score was higher in PECB (4.32?0.47 vs 4.12?0.33; p=0.416). Though, the difference was statistically not significant. There was no significant difference between mean VAS score of both groups at all-time interval (p>0.05). Throughout the study duration VAS score remained below 3. Conclusion: From our study it was concluded that both TPVB and PEC block are equally effective for postoperative analgesia in MRM as duration of analgesia and patient satisfaction score were statistically comparable with no side effects.

Keywords: Bupivacaine, Thoracic Paravertebral block, Pec block