The effect of pectointercostal fascia block performed in addition to serratusanterior plan block on postoperative analgesia in breast reduction operations

The Effect of Pectointercostal Fascia Block Performed in Addition to Serratus Anterior Plan Block on Postoperative Analgesia in Breast Reduction Operations Purpose: In our study, we aimed to investigate the effect of performing another plan block, pectointercostal fascia plan block (PIFB), on postoperative morphine consumption and postoperative pain scores (both rest and movement) in patients who underwent Serratus anterior plan block (SAPB) before bilateral breast reduction surgery. Materials and Methods: After ethics committee approval and informed consent form were obtained, 64 patients aged 18 years and older in ASA I-II class were included in the study and divided into two groups by computer-mediated randomisation. After the patients were taken to the operating room, standard monitoring and Bispectral Index (BIS) monitoring were performed and general anesthesia induction was performed with 2 mg/kg propofol, 0.6 mg/kg rocuronium and 2 µg/kg fentanyl in all patients and maintenance was provided with sevoflurane 1-2%, 40/60% O2/air, remifentanil infusion. The depth of anesthesia was adjusted so that the BIS value would be between 40 and 60. After endotracheal intubation, patients in Group I received SAPB (20 ml of 0.25% bupivacaine bilaterally) in addition to PIFB (15 ml of 0.25% bupivacaine bilaterally). In group II, only SAPB (20 ml of 0.25% bupivacaine bilaterally) was performed. Intraoperative haemodynamic data, sevoflurane and remifentanil consumption, duration of surgery, extubation time, and duration of stay in the postanaesthetic care unit (PACU) were recorded. Patient-controlled analgesia with iv morphine was provided to all patients postoperatively (1 mg bolus, 10 min lock time, 4-hour limit 10 mg). Morphine consumption, number of morphine demands, visual analogue pain scores (VAS) at rest and during movement, additional analgesic requirement, sensory block monitoring, postoperative nausea-vomiting (PONV), and presence of complications were recorded at postoperative first 24-hours. Results: The groups were similar in terms of demographic data, surgery duration, extubation time, time to stay in post-anesthesia care unit (PACU), intraoperative consumption of sevoflurane and remifentanil. Postoperative 24-hours morphine consumption was found to be 3.7±2.2 mg in Group I and 7.9±2.3 mg in Group II (p<0.05). The number of postoperative morphine requests were 4.5±2.7 in Group I and 10.4±3.7 in Group II (p<0.05). At the first 24 hours postoperatively, both resting and moving VAS scores were higher in Group II than in Group I (p<0.05). There was no difference between the groups in terms of PONV and no complication was observed in both groups. The duration of sensorial block was similar between the groups at the first postoperative 24 hours. There was no difference between the groups in terms of additional analgesic demand (p>0.05). Conclusion: It was concluded that the addition of PIFB to preoperative SAPB in breast reduction surgery reduces morphine consumption and pain scores at the first 24 hours postoperatively compared to SAPB alone without causing any complications. We think that the addition of PIFB to other plan blocks may provide a comfortable postoperative period. KeyWords: Breast reduction surgery, pectointercostal fascia plan block, postoperative pain scores, postoperative opioid consumption, serratus anterior plane block.