US-Guided PECS II Block Versus MTP Block For Postoperative Analgesia Of MRM Sugery

Analgesia Clinical Trial

Official title: Ultrasound-Guided Modified Pectoral Plane (PECS II) Block Versus Midpoint Transverse Process To Pleura (MTP) Block For Postoperative Analgesia Of Modified Radical Mastectomy

Status Recruiting

Clinical Trial Summary

This study aims to compare the analgesic efficacies of the modified pectoral plane block (PECS II) and the midpoint transverse process to pleura block (MTP), after modified radical mastectomy (MRM) surgery during the first 24 hour post-operatively by using the Visual Analogue Scale.

Clinical Trial Description

During Modified radical mastectomy (MRM), some of the nerves in the chest are severed. Most women have some level of pain in the days after the procedure. Severe acute postoperative pain following breast surgery not only increases the risk of persistent pain and affects recovery, it also leads to longer hospitalization and increased healthcare costs. Acute postoperative pain is an independent risk factor in the development of chronic post-mastectomy pain.

PECS-II is an interfascial plane block in which local anesthetic is injected between the pectoralis and serratus anterior muscles that blocks the long thoracic nerve as well as the pectoral, intercostobrachial, and inter-costal III, IV, V, and VI nerves. PECS-II is a less invasive and easier to perform alternative to thoracic paravertebral block (TPVB). This block, defined by Blanco et al., provides adequate and safe post-operative analgesia in the anterior chest wall after breast surgery. The most common complications are pneumothorax, infection, local anesthetic systemic toxicity (LAST)/allergy, vascular puncture, and failed block.

The MTP block was first described as a modified paravertebral block in 2017. The local anesthetic (LA) is administered between the transverse process and the pleura. This results in a LA spread to the dorsal and ventral rami in the paravertebral space through the fenestrations in the superior costotransverse ligament (SCTL) at the level of injection, and frequently to adjacent levels. The advantage of this novel technique is that it does not require identification of the SCTL and the injection point, which is midway between the pleura and transverse process, which makes this approach much safer than the conventional TPVB approach since the needle is farther from the vital structures like pleura, nerves, and vasculature. This technique is used for pain relief after mastectomy, thoracic, abdominal, and spinal surgery and was found effective due to its simplicity and lower risks compared to epidural analgesia. ;

Related Conditions & MeSH terms

• Analgesia
• Anesthesia, Local
• Neuromuscular Blockade
• Pain, Postoperative
• Post Operative Pain

• NCT number: NCT06187909
• Study type: Interventional
• Source: Ain Shams University
• Contact: Diaa eldin M. haiba, phD
• Phone: 01006516286
• Email: beethoven_1993@windowslive.com
• Status: Recruiting
• Phase: N/A
• Start date: March 1, 2024
• Completion date: January 10, 2025