Breast cancer remains the most frequently diagnosed cancer and a major cause of cancer-related mortality among women worldwide. Modified radical mastectomy (MRM), a common surgical procedure for breast cancer, is associated with significant postoperative pain, which may delay recovery and contribute to the development of chronic postmastectomy pain syndrome (PMPS). To address this, regional anesthesia techniques have been increasingly incorporated into multimodal analgesia strategies to reduce opioid consumption and enhance patient outcomes. Interfascial plane blocks, in particular, offer safe and effective analgesia under ultrasound guidance. The erector spinae plane block (ESPB), first described in 2016, involves injection of local anesthetic deep to the erector spinae muscle and may spread to the paravertebral space, providing both somatic and visceral analgesia. A bilevel approach may enhance dermatomal coverage. Meanwhile, the pectoserratus plane block (PSPB), which combines PECS II and serratus anterior blocks, targets nerves of the anterior and lateral chest wall and has shown efficacy in breast surgery
Breast cancer female patients.
ASA class II and III.
Age ≥ 18 and ≤ 65 Years.
Body mass index (BMI): > 20 kg/m2 and < 35 kg/m2.
Patient refusal.
Age <18 years or >65 years.
BMI <20 kg/m2 and >35 kg/m2.
Major medical conditions.
Parallel
Ultrasound guided bilevel Erector spinae plane block (ESPB)
Procedure/SurgeryUltrasound guided bilevel Erector spinae plane block
Ultrasound guided Pectoserratus Block
Procedure/Surgeryultra sound guided combined Pectoral Nerve (PECS II) Block and Serratus anterior (SAPB) plane block
Total post-operative morphine consumption.
The total 24-hour morphine consumption will be recorded for every patient post operative.
Total intra-operative fentanyl consumption
the rescue analgesia will be administered intra-operative by fentanyl IV and the total fentanyl used will be recorded and compared between the groups
1st time opioids requested post-operative.
In case of postoperative pain recorded, rescue analgesia will be provided as IV morphine (3 mg) then continuous infusion of morphine through Patient Controlled Analgesia ( PCA ) to keep the VAS scores\<3. The total 24-hour morphine consumption will be recorded for every patient.
Changes and stability in Mean Arterial Blood Pressure (MAP)
Change in Mean Arterial Blood Pressure (MAP) in mmHg
Changes and stability in Heart Rate (HR)
Change in heart rate (HR) in beat\\min
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