Pectoral plane block compared to erector spinae plane block in multimodal analgesia for modified radical mastectomy patients –a prospective randomized controlled trial

Abstract

Background & Objectives: Effective perioperative analgesia is essential in patients undergoing modified radical
mastectomy to reduce opioid consumption, enhance recovery, and improve patient satisfaction. Regional anesthesia techniques such as the Pectoral Plane (PECS) block and the Erector Spinae Plane (ESP) block have been evolved as promising alternatives, though their comparative efficacy remains under debate. The primary objective of this trial was to observe intra operative mean morphine consumption and mean morphine consumption in first 12 hours post operatively. The secondary objective was to assess the pain scores at 1, 6 and 12 hours post operatively
Methodology: In this prospective, randomized controlled trial, 42 patients scheduled for elective modified radical mastectomy were randomized into two groups: Group ESP and Group PECS. Standardized general anesthesia was administered in all patients. Intraoperative mean morphine consumption, postoperative mean morphine consumption at 12 hours, and pain scores at 1, 6, and 12 hours postoperatively were recorded using numerical rating scale (NRS).
Results: Group PECS provided effective postoperative analgesia compared to Group ESP. Patients in Group ESP
demonstrated significantly lower mean postoperative morphine consumption and pain scores in the early
postoperative period compared to Group PECS (P < 0.05). No major complications were observed in either group.
Conclusion: Both PECS and ESP blocks are safe and effective regional anesthesia techniques for modified radical mastectomy. However, the PECS block demonstrated superior early postoperative analgesia and reduced
postoperative morphine consumption compared to ESP block.
Abbreviations: ERAS: enhanced recovery after surgery, ESP: Erector Spinae Plane, PACU: Post-Anesthesia Care Unit, PECS: Pectoral Plane, PMPS: Post-Mastectomy Pain Syndrome
Keywords: Multimodal analgesia, Pectoral plane block, Erector spine plane block, modified radical mastectomy
Faisal M, et al Pectoral plane block vs erector spinae plane block
Citation: Faisal M, Afzal A, Bin Khalid H, Ur Rehman H, Ashfaq AD, Mehdi SR. Pectoral plane block compared to
erector spinae plane block in multimodal analgesia for modified radical mastectomy patients –a prospective
randomized controlled trial. Anaesth. pain intensive care 2025;30(1):40-46. DOI: 10.35975/apic.v30i1.3100
Received: October 14, 2025; Revised: November 04, 2025; Accepted: November 05, 2025