THORACIC PARAVERTEBRAL BLOCK VERSUS PECTORAL NERVE BLOCK FOR ANALGESIA AFTER MODIFIED RADICAL MASTECTOMY

Abstract

Background: Postoperative pain control is essential for early recovery, patient comfort, and reduced opioid requirement after modified radical mastectomy with immediate breast reconstruction.

Objective: To compare thoracic paravertebral block and pectoral nerve block in terms of postoperative pain scores, nalbuphine requirement, time to rescue analgesia, and complications after modified radical mastectomy surgery.

Materials and Methods: This randomized controlled trial was conducted in the Department of Anesthesia, Jinnah Hospital, Lahore from April 2022 to November 2022. A total of 54 patients undergoing modified radical mastectomy were included after informed consent and randomly allocated into two equal groups. Group A received thoracic paravertebral block, while Group B received pectoral nerve block. General anesthesia was induced using nalbuphine 0.1 mg/kg, propofol 2 mg/kg, and atracurium 0.5 mg/kg in all patients.

Results: At rest in the post-anesthesia care unit, the mean NRS score was 1.44 ± 0.51 in the paravertebral block group and 1.48 ± 0.51 in the pectoral nerve block group (p=0.790). At 8 hours, the mean resting NRS score was significantly higher in the paravertebral block group compared with the pectoral nerve block group (4.15 ± 0.60 vs 3.48 ± 0.58; p<0.001). On movement in the post-anesthesia care unit, the mean NRS score was 2.67 ± 0.48 in the paravertebral block group and 2.41 ± 0.50 in the pectoral nerve block group (p=0.058). At 8 hours, movement-related pain was significantly higher in the paravertebral block group than in the pectoral nerve block group (4.52 ± 0.70 vs 3.70 ± 0.67; p<0.001).

Conclusion: Pectoral nerve block provided better postoperative analgesia, lower pain scores at 8 hours, and longer duration before rescue analgesia compared with thoracic paravertebral block after modified radical mastectomy surgery. Both techniques were safe, with no observed complications.