The Effectiveness of PECS II Block on PONV and Rescue Opioid Dose in Post–Modified Radical Mastectomy Patients

Waldemar P Siahaan, Barry Imanuel Kambey, Garry Dietmar Chrysogonus Kumaat, Venesa Laurent Ngantung

Abstract

Background: Modified radical mastectomy (MRM) remains a mainstay for breast cancer but is associated with significant postoperative pain and postoperative nausea and vomiting (PONV). Pectoralis II (PECS II) block offers targeted chest wall analgesia with potential opioid‐sparing and antiemetic benefits. This study aimed to assess the effectiveness of PECS II block on PONV and rescue opioid dose in post-modified radical mastectomy patients.

Methods: This single‐blind randomized trial included 32 women (30–65 years) undergoing MRM were allocated to general anesthesia (GA; n=16) or GA combined with ultrasound‐guided PECS II block (GA+PECS; n=16). Primary outcome was the mean numeric rating scale (NRS) score in the first 24 hours. Secondary outcomes included incidence of postoperative nausea and vomiting (PONV) and need for rescue opioid. Sample size was calculated to detect a 2‐point NRS difference (SD 2, α=0.05, β=0.20). The data were analysed using independent t‐tests for continuous data and χ² or Fisher’s exact test for categoric data.

Results: Mean NRS was significantly lower in GA+PECS (1.38 ± 0.50) versus GA alone (3.44 ± 1.37, p< 0.001). PONV occurred in 5/16 (31.3%) of GA patients and 0/16 (0%) of GA+PECS patients (p-value = 0.02). Rescue opioid was required in 1/16 (6.3%) of GA patients versus none in GA+PECS (p-value = 0.31).

Conclusion: Adding PECS II block to GA in MRM substantially improves postoperative pain control and eliminates PONV, with minimal opioid rescue. Larger multicenter studies are warranted to confirm these findings.

Keywords

Mastectomy; Opioid; PECS block; PONV.

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DOI: https://doi.org/10.20961/soja.v6i1.112962

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