Ultrasound PECS 2 Versus Dexmedetomidine Infusion for Pain Management after Radical Mastectomy

Background: Pectoralis-Serratus interfascial plane block is a peripheral block of the thoracic wall that presents analgesia of its anterolateral portion. Dexmedetomidine, a specific α-2 adrenoceptor agonist, has sedative, anxiolytic, and analgesic properties. The aim of this work was to assess the analgesic safety and efficacy of Pectoralis-Serratus interfascial plane block in contrast with dexmedetomidine infusion for unilateral radical mastectomy.

Methods: This prospective randomized study was carried out on 60 adult patients with American Society of Anaesthesiologists (ASA) physical status I/II scheduled for elective unilateral radical mastectomy. The cases were classified randomly into two equal groups: group I: received ultrasound guided pectoralis serratus interfacial plane block and group II: received dexmedetomidine infusion. All patients were subjected to routine laboratory investigations (coagulation profile, CBC, liver and renal function tests) and visual analogue scale (VAS).

Results: Total amount of fentanyl increments, Ramsey sedation score and total analgesic (morphine) consumption in the 1st 24 hours postoperative were significantly decreased in group I contrasted to group II (P<0.001). Time of the first rescue analgesia was significantly increased in group I than group II (P <0.001). Bradycardia was considerably decreased in group I than group II (P = 0.026). VAS at rest and at exercise were significantly decreased at 1, 2, 4 and 6 hours in group I than group II (P<0.05).

Conclusions: PECS-II blocks are superior to dexmedetomidine infusion provide adequate post-operative analgesia (lower VAS and total analgesic consumption with increased 1st rescue analgesia) with hemodynamic stability. and less complications.