PECSATT block: Advancing opioid-free anesthesia in breast surgery

Opioid-based general anaesthesia is associated with increased nausea and vomiting, respiratory depression, prolonged sedation, urine retention, ileus, hyperalgesia, tolerance, and chronic pain. The aim of this study was to assess the impact of various regional block techniques for opioid free anaesthesia in breast surgeries in the peri-operative period.

This prospective, randomized controlled study included 40 women ASA I to III for modified radical mastectomy at a tertiary care institute between September 2021-2022. Group PST (n-20) received opioid free general anaesthesia followed by quadruple block (PECS I & II, Serratus anterior plane muscle block, transverse thoracic muscle plane block) and Group PS (n-20) had general anaesthesia followed by PECS I & II and Serratus anterior plane muscle block. The primary outcome measured was the impact of various regional block techniques for opioid free anaesthesia in breast surgeries perioperatively. Secondary outcomes were the effect of regional block techniques on fasttracking, analgesic requirement, surgeon and patient satisfaction scores.

Real-time ultrasound-guided regional blocks was performed by single experienced operator. The intraoperative intravenous fentanyl requirement was statistically lower in PST group as compared with the PS group (p value= 0.01447). Group PS had significantly increased (p < 0.05) HR during skin incision and 10 mins after whereas for MAP there was significantly increase during skin incision, after 10 mins, 20 mins and 30 mins than in group PST (p < 0.05). Postoperative data were comparable between the groups

The quadruple block provided complete analgesia for the breast surgeries thereby decreasing the perioperative opioid requirements.