The study will compare ultrasound-guided Pectoral nerve block, Erector Spinae Plane block, and Serratus anterior plane block for pain management following elective breast surgeries
None
Patient refusal to participate in research.
Body Mass Index (BMI) ≥35 kg/m2.
Sensitivity to the intervention drugs.
Coagulation abnormalities.
Parallel
Pectoral nerve block (PECS)
DrugPatients will receive pectoral nerve block (PECS).
Erector spinae plane block (ESP)
DrugPatients will receive erector spinae plane block (ESP).
Serratus anterior plane block (SAP)
DrugPatients will receive serratus anterior plane block (SAP).
Total morphine consumption
Rescue analgesia of morphine will be given as 3 mg bolus if the visual analogue scale (VAS) ≥ 4 to be repeated after 30 min if pain persists until the VAS\< 4.
Time to the 1st rescue analgesia
Time to 1st request for the rescue of analgesia (time from the end of surgery till first dose of morphine administrated) will be recorded.
Intraoperative fentanyl consumption
Intraoperative fentanyl consumption will be recorded.Additional fentanyl bolus dosages of 0.5 µg/kg IV will be administered if mean arterial blood pressure and heart rate elevated more than 20% of the baseline (after exclusion of other causes).
Pain degree
Each patient will be instructed about postoperative pain assessment with the visual analogue scale (VAS) (20), from 0 to 10 (0 represents "no pain" while 10 represents "the worst pain imaginable").Rescue analgesia of morphine will be given as 3 mg bolus if the VAS ≥ 4 to be repeated after 30 min if pain persists until the VAS\< 4. VAS will be assessed at 30min, 2, 6,12 and 24 h postoperatively
Mean arterial blood pressure
Intraoperative hemodynamic parameters: Mean arterial blood pressure (MAP) will be recorded at baseline, after performing of block, and every 15 min till the end of surgery.
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