Investigation of the effectiveness of pectoralis nerve block added to erector spinae plane block in breast cancer patients against erector spina plan block alone

Breast cancer is a type of cancer detected very frequently in the female gender, and acute pain after surgery, especially the transformation of acute pain into permanent pain, is the most severe problem in the postoperative period. This study aimed to activate postoperative analgesia, prevent chronic pain, decrease pain scores, and reduce opioid consumption and opioid-related side effects in patients undergoing breast cancer surgery. Fifty patients (Female gender, aged 18-75 years, without hematological disease) who underwent breast cancer surgery were included in the study. The patients were divided into those who underwent erector spina plane block and those who underwent pectoralis nerve block added to the erector spina plane block. In both groups, blocks were applied preoperatively using 20 ml of 0.25% bupivacaine. All patients were given general anesthesia for the surgery. In the postoperative period, patient-controlled analgesia (PCA) with tramadol (tramadol 300 mg was put into 100 cc serum isotonic at 3 mg/cc, three cc/hour infusion, bolus dose five ccs, lock-in time will be 4 hours and will stay for 24 hours) was applied. Tenoxicam was administered to all patients before extubation. When the resting visual analog scale (VAS) score was >4 despite the PCA request for tramadol, iv paracetamol was administered as rescue analgesia. As a measure, the patients' VAS scores at the postoperative 30th minute, 1, 2, 4, 8, 12, and 24 hours after surgery, PCA, and side effects such as nausea, vomiting, need for antiemetics, constipation, itching, urinary retention, dry mouth due to opioid use. Whether there are effects at intervals of 0-4 hours, 4-8 hours, 8-24 hours, and in total, The amount of tramadol bolus dose used, the total dose of bolus and infusion, and the amount of paracetamol administered as rescue analgesia was used. In the pectoralis block group added to the erector spina plane block, VAS scores, postoperative 24-hour tramadol consumption, side effects due to opioid use, and the need for rescue analgesia were found to be statistically significantly lower than in the erector spina plane block group. In our study, it has been shown that the pectoralis nerve block added to the erector spinae plan block, which is applied under the guidance of USG as a part of multimodal analgesia, provides adequate analgesia on postoperative acute pain in patients undergoing breast cancer surgery.