Abstract

Modified Radical Mastectomy (MRM) is associated with significant postoperative pain. Regional anesthesia techniques like Pectoral Nerve Block (PECS) and Erector Spinae Plane Block (ESPB) have emerged as effective analgesic modalities. This study compares the efficacy of ultrasound-guided PECS block versus ESPB for postoperative analgesia in MRM patients. This prospective, randomized, double-blind study included 120 patients undergoing MRM, divided into two groups (n=60 each). Group P received PECS II block with 30ml of 0.25% bupivacaine, while Group E received ESPB at T4 level with the same dose. Primary outcome was 24-hour postoperative morphine consumption. Secondary outcomes included Visual Analog Scale (VAS) scores, time to first rescue analgesia, patient satisfaction, and complications. Mean 24-hour morphine consumption was significantly lower in Group P (8.4±2.3mg) compared to Group E (12.6±3.1mg) (p<0.001). VAS scores were lower in Group P at 2, 4, and 6 hours postoperatively (p<0.05). Time to first rescue analgesia was longer in Group P (386±45 minutes) versus Group E (248±38 minutes) (p<0.001). Patient satisfaction scores were higher in Group P (8.9±0.8) compared to Group E (7.6±1.2) (p<0.001). No significant complications were observed in either group. Ultrasound-guided PECS II block provides superior postoperative analgesia compared to ESPB in patients undergoing MRM, with reduced opioid consumption, better pain scores, and higher patient satisfaction.