Background and Goal of Study: Having demonstrated that PECs ( Pectoral block ) based anesthesia without opioids has decreased analgesic requirement, pain scores and PONV compared to conventional general anesthesia in patients of modified radical mastectomy and axillary dissection (MRM- AD) we wished  to compare PECS vs Paravertebral Blocks (PVB)  in an opioid free, nerve block based anesthesia. Outcomes of interest were  post operative analgesic requirement, duration of analgesia, PONV and satisfaction of patient and surgeons. Materials and Methods: This randomized double blind study involving 58 adult ASA I-III patients posted for MRM-AD in a 500 bedded university hospital. After randomization and allocation concealment patients were induced with propofol and maintained on spontaneous ventilation with isoflurane (0.8- 1.0 MAC) through i-gel. Ultrasound guided PECS or paravertebral blocks (0.1% lignocaine+0.25% bupivacaine+1 mcg /kg dexmedetomidine, 30ml) were administered. Intraoperative events, post-operative pain scores and analgesic requirement over 24 hours, PONV, satisfaction of surgeon and patient were measured. Results- Between the two groups, there was no difference in demographics, ASA status, location and volume of breast tumour excised or the duration of surgery. The time from block to incision was significantly more in the PV group (p = 0.01). There was no difference between the two groups in terms of intra and post operative parameters, and the median VAS scores for pain at rest or during shoulder abduction was similar in both the groups.  Discussion- Duration of analgesia is similar between Pecs or PVB block aided opioid free anesthesia for MRM-AD.Time from block to incision is less and surgeon satisfaction better with PECS. This is unlike the results of Wahba et al and Kulhari et al where Pecs block was superior to paravertebral block. Conclusion- Both Pecs and Paravertebral blocks result in prolonged analgesia and decreased requirement of non-opiate opioid analgesics when administered in a opioid free regimen. Pecs block is associated with less time to incision and is preferred by surgeons. Incidence of PONV and complications are low. Benefits of routine used of these blocks to avoid opioid related complications may be studied futher.



03 / Comparison of 2 types of ultrasound guided nerve blocks in patients undergoing breast cancer surgery under opioid free anaesthesia. A Randomised study.