Investigation of postoperative analgesic efficacy of PECS 2 block with combination of serratus plane block and transverse thoracic muscular plane block in patients undergoing modified radical mastectomy.

SPB+TTP blocks: In the SPB, the patient was placed on the operating table in the supine position, and the arm was abducted. A linear ultrasound probe was placed on the middle and posterior axillary lines at the 5th intercostal level in the axillary fossa, and 20 ml of 0.25% bupivacaine was injected between the serratus anterior and latissimus dorsi muscles. For the TTP block, 20 ml of 0.25% bupivacaine was injected between the transversus thoracic muscle and the intercostal muscle between the fourth and fifth ribs attached to the sternum. Postoperative Management: The same protocol was applied to both study groups to provide postoperative analgesia. At the end of the operation, 1 g of paracetamol IV and 50 mcg of fentanyl IV were administered. Patient Contrelled Analgesia (PCA) was inserted in the recovery room and maintained (fentanyl 10 mcg/ml, basal infusion: 0, locking time: 15 min, demand dose: 25 mcg). Patients with an Aldrete score of 9 and above were referred to the inpatient service. PCA treatment was continued for 24 hours. Postoperative follow-up procedures and evaluations of the patients were performed by a researcher who was not aware of the study groups. Patient pain was monitored with a visual analog scale (VAS) (VAS 0 = no pain, VAS 10 = unbearable pain). VAS scores were recorded at 0, 1, 2, 4, 6, 8, 12, 16 and 24 hours postoperatively. The time to first analgesic requirement was defined as the time between the time of extubation and the time when the VAS pain score was =4. Postoperative opioid consumption was recorded as the amount consumed in the 0–4 hour, 4–8 hour, 8–12 hour, and 12–24 hour periods and total consumption within 24 hours. All adverse events related to blocks and opioids (nausea, vomiting, constipation, urinary retention, hypotension, hematoma) were recorded. For patients with a VAS score of 4 or above, 25 mcg meperidine was administered intravenously. The pain scores of the patients at rest were recorded via the VAS-R, and the pain scores detected after the patients raised their arms to 90 degrees were recorded via the VAS-A. Patient satisfaction was evaluated. For this assessment, responses of 1=excellent, 2=good, 3=moderate and 4=poor were accepted and scored.