Comparison of recovery status, haemodynamic parameter and postoperative analgesia in combined general anaesthesia with pectoral nerve block II and general anaesthesia for modified radical mastectomy

Open Access

Abstract

Nasima Sultana1, Rahnuma Tasnim2, Ayesha Sultana3, Shamim Ara Sultana4, Mehedi Masud5, Sheikh Imran Alam6, Abdur Razzaque7, Parvin Akter8, Mohammad Mominul Haque9* Background: Modified radical mastectomy is associated with significant postoperative pain requiring effective multimodal analgesia. General anaesthesia alone may not provide adequate pain control, leading to increased opioid consumption and delayed recovery. Ultrasound-guided pectoral nerve block II (PECS II) has emerged as an effective regional technique to improve postoperative analgesia in breast surgery. Methods & Materials: This prospective randomized controlled trial was conducted in the Department of Anaesthesia, Analgesia and Intensive Care Medicine and the Department of General Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 2021 to October 2022. Results: Baseline characteristics including age, weight and ASA grade were comparable between groups (p>0.05). Mean arterial pressure was significantly lower in the PECS II group at 15 minutes intraoperatively (p<0.001), while other time points showed no difference. Postoperative VAS scores were significantly lower in Group B both in recovery (1.2 ± 0.4 vs 4.3 ± 0.7) and at 6 hours (p<0.001). Time to first rescue analgesia was significantly prolonged in Group B (144.0 ± 68.9 vs 38.0 ± 13.5 min), with reduced pethidine consumption (72.5 ± 7.9 vs 120.0 ± 10.0 mg). Higher Modified Aldrete Scores >9 were observed in Group B (76.7% vs 20%). PONV and opioid-related complications were also lower in Group B. Conclusion: PECS II block combined with general anaesthesia provides superior postoperative analgesia, reduces opioid requirement, improves recovery profile and maintains hemodynamic stability in patients undergoing modified radical mastectomy.