Combined pectoralis II block and transversus thoracic plane block compared to erector spinae plane block for post-operative analgesia in patients undergoing modified radical mastectomy: A randomized clinical trial

Figures & data

Figure 1. Consort flow chart of the two studied groups.

Group E: Erector Spinae Block (ESPB); Group P: Modified pectoralis nerve block plus transversus thoracic plane block (PECS-II-TTP);.

Figure 2. Ultrasonographic visualization of different study blocks.

A: Erector spinae plane block (ESPB). B: Modified pectoralis nerve block (PECS II block). C: Transverses thoracic plane block (TTP).

Table 1. Demographic and baseline data, operative time, fluid intake, procedure-related complications (hypotension), ephedrine dose, and post-operative complications in the two studied groups.

	Group E (n = 30)	Group P (n = 30)	P value
Age (years)	54.67 ± 7.24	51.44 ± 9.97	0.21
Body mass index (kg/m^2)	30.83 ± 2.65	31.43 ± 2.82	0.55
ASA class			0.60
Class-I	16 (53.3%)	15 (50%)
Class-II	14 (46.7%)	15 (50%)
Operative time (minute)	121.60 ± 13.45	125.23 ± 12.98	0.50
Fluid intake (l)	1.68 ± 0.25	1.67 ± 0.27	0.80
Procedural-related complications (hypotension)			0.29
No	18 (60%)	21 (70%)
Yes	12 (40%)	9 (30%)
Ephedrine dose (mg)	3.80 ± 0.97	3 ± 1.61	0.40
Postoperative complications
Nausea	4 (13.3%)	5 (16.7%)	0.67
Vomiting	4 (13.3%)	2 (6.7%)	0.57

Data is expressed as mean ± (SD), frequency (percentage), test used (Chi2test), and student t-test. P-value was significant if < 0.05.

Group E: Erector Spinae Block (ESPB); Group P: Modified pectoralis nerve block plus transversus thoracic plane block (PECS-II-TTP).

ASA: American Society of Anesthesiologists.

Table 2. Recovery time, morphine consumption, time to first analgesia, and IL6 levels among the studied groups.

	Group E (n = 30)	Group P (n = 30)	P value
Recovery time (minute)	11.17 ± 2.27	9.83 ± 1.82	0.01*
Morphin consumption (mg/24 hr)	0.93 ± 0.63	2.13 ± 0.42	0.03*
Time to first analgesia (hours)	6.13 ± 3.43	8.13 ± 1.53	0.23
Interleukin-6
Baseline	10.03 ± 4.09	10.73 ± 3.54	0.48
After 24hrs	239.01 ± 122.11	278.08 ± 151.29	0.30

Data is expressed as mean ± (SD). The test used (student t-test).

P value was significant if < 0.05.

*Significant difference.

Group E: Erector Spinae Block (ESPB); Group P: Modified pectoralis nerve block plus transversus thoracic plane block (PECS II-TTP).

Figure 3. Numeric rating scale (NRS) in the two studied groups.

Group E: Erector Spinae Block (ESPB); Group P: Modified pectoralis nerve block plus transversus thoracic plane block (PECS-II-TTP);.

Figure 4. Perioperative assessment of Mean arterial blood pressure (MAP) changes in the two studied groups.

Group E: Erector Spinae Block (ESPB); Group P: Modified pectoralis nerve block plus transversus thoracic plane block (PECS-II-TTP);.