Comparison of the Effects of Intraoperative Pectoral Nerve Block and Local Wound Infiltration in Pain Management for Breast Cancer Surgery: A Randomized Controlled Trial.

PURPOSE: To evaluate the postoperative analgesic effects and opioid-sparing benefits of the intraoperative surgeon-performed pectoral nerve (PECS) block technique in mastectomy patients, compared with traditional local infiltration anesthesia.

DESIGN

The research is a randomized controlled clinical trial.

METHODS

Participants were randomly assigned to two groups: the PECS group, which received PECS I and II and a serratus plane block, and the control group, which received local infiltration anesthesia. After surgical resection, the PECS group received 0.5% bupivacaine around the pectoralis and serratus muscles, whereas the control group received it at the surgical site. Primary outcomes included time to the first analgesia request and total postoperative morphine use, with secondary outcomes being Numerical Rating Scale pain scores over 24 hours.

FINDINGS: The mean time to the first analgesia request and the total morphine dose were 1,320 minutes and 1 mg, respectively, in the PECS group, compared with 79 minutes and 3 mg in the local infiltration group (P = .013 and P = .003, respectively). A significantly greater proportion of patients in the PECS group reported mild pain scores than those in the local infiltration group. No adverse effects were observed in either group.

CONCLUSIONS

Using the PECS block under direct visualization is feasible, significantly reduces analgesic requirements, can be performed without a significant increase in operative time, and does not require specialized equipment.