Comparison of the effectiveness of the SPB and TTP block combinations versus the PECS 2 block in modified radical mastectomy: a prospective randomized study

Abstract

The aim of this study was to compare the analgesic efficacy of a combination of serratus plane block (SPB) and transversus thoracic plane (TTP) block with pectoral nerve block (PECS) 2 in patients undergoing modified radical mastectomy (MRM) surgery. Sixty patients in the ASA I-III classification, aged between 18 and 75 years, who agreed to participate in the study and would undergo MRM surgery, were included in the study. The patients were divided into two groups. Before the surgery, PECS 2 block (30mL, 0.25% bupivacaine) was applied to Group 1 ( n = 30), while SPB (20mL, 0.25% bupivacaine) and TTP (20mL, 0.25% bupivacaine) block were applied to Group 2 ( n = 30). Patient controlled analgesia (PCA) protocol (fentanyl concentration: 10mcg/ml, no basal infusion, demand dose: 25mcg) was administered for 24 h postoperatively. Primary endpoint was opioid consumption during the first 24 h postoperatively. Secondary endpoints were VAS score, adverse effects, and patient satisfaction assessment in the first 24 h postoperatively. There were no significant differences in age, body mass index (BMI), ASA classification, and duration of anesthesia between the groups ( p > 0.05). No significant differences were found in post-operative VAS scores ( p > 0.05), opioid consumption ( p = 0.63), number of additional rescue analgesics ( p = 0.22) and time to first rescue analgesic requirement ( p = 0.15) between the groups. There were also no significant differences in postoperative nausea, vomiting or patient satisfaction scores between the groups ( p > 0.05). The combination of SPB and TTP blocks in MRM did not exhibit superiority in terms of analgesia and patient satisfaction during the first 24 h postoperative course compared to the PECS 2 block. Australian New Zealand Clinical Trials Registry. anzctr.org.au Trial Id: ACTRN12625001079437, 03 October 2025 (Retrospectively registered).