The Analgesic Efficacy of Pecto-Intercostal Fascial Block Combined With Pectoral Nerve Block II Versus Serratus Plane Block in Modified Radical Mastectomy
NCT ID: NCT07247448
Last Updated: 2025-12-02
Study Results
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Basic Information
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ACTIVE_NOT_RECRUITING
NA
70 participants
INTERVENTIONAL
2025-10-15
2026-11-30
Brief Summary
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
Group A (PIFB-PECS II): 35 patients will receive 40 mL of 0.25% bupivacaine.
* PECS II block divided into 2 injections.
1. 10 ml between the pectoralis major and pectoralis minor
2. 20 ml between the pectoralis minor and stratus anterior muscle
* PIFB 10 mL between the pectoralis major and the intercostal muscle. Group B (Serratus plane block): 35 patients will receive 40 mL of 0. 25% bupivacaine.
SUPPORTIVE_CARE
NONE
Study Groups
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PIFB-PECS II
PECS II block
Ultrasound-Guided PECS II Block With the patient in a supine position, her arm in a neutral position, and under complete aseptic technique, a 6 to 13 MHz ultrasound linear transducer probe (Mindray, Shen zhen, China) will be positioned below the distal one-third of the clavicle to visualize the pectoralis major and minor muscles, SAM, pectoral branch of the thoracoacromial artery, the second and third ribs, and the external intercostal muscles between the ribs. The needle will be inserted in-plane in a medial-to-lateral direction until its tip is placed between the SAM and the external intercostal muscles. The first injection will be done below the SAM using 20 mL bupivacaine 0.25% at the level of the second rib to block the intercostobrachial nerves and the lateral branches of the third to the sixth intercostal nerves. The needle will be withdrawn until its tip is placed between the pectoralis major and minor muscles, and an additional 10 mL of bupivacaine 0.25% will be injected.
PIFB
Ultrasound-Guided PIFB Under complete aseptic technique with the patient in the supine position, a 6 to 13 MHz ultrasound linear transducer probe (Mindray, Shen zhen, China) will be placed 2 or 3 cm parallel to the long axis of the sternal bone to identify the second to fourth costal cartilages and targeting the fourth costal cartilage The needle will be inserted in-plane with the US probe, in a caudal-to-cranial direction. The needle will be advanced until the tip is positioned in the interfascial plane between the pectoralis major muscle and the intercostal muscle. After confirmation of the correct position of the tip of the needle, as shown by separation of the fascial layers on injecting 2 mL normal saline solution, 10 mL of bupivacaine 0.25% will be injected.
SAPB
SAPB block
Ultrasound-Guided Serratus Anterior Plane Block (SAPB) The probe will be placed on the mid-axillary line at the level of the fourth rib to visualize the serratus anterior and latissimus dorsi muscles. After establishing the correct level, the needle will be introduced in-plane. After puncturing the serratus muscle and contacting the rib, 40 mL of bupivacaine 0.25% will be deposited between the serratus muscle fascia and the rib periosteum, termed a deep serratus anterior plane block.
Interventions
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PECS II block
Ultrasound-Guided PECS II Block With the patient in a supine position, her arm in a neutral position, and under complete aseptic technique, a 6 to 13 MHz ultrasound linear transducer probe (Mindray, Shen zhen, China) will be positioned below the distal one-third of the clavicle to visualize the pectoralis major and minor muscles, SAM, pectoral branch of the thoracoacromial artery, the second and third ribs, and the external intercostal muscles between the ribs. The needle will be inserted in-plane in a medial-to-lateral direction until its tip is placed between the SAM and the external intercostal muscles. The first injection will be done below the SAM using 20 mL bupivacaine 0.25% at the level of the second rib to block the intercostobrachial nerves and the lateral branches of the third to the sixth intercostal nerves. The needle will be withdrawn until its tip is placed between the pectoralis major and minor muscles, and an additional 10 mL of bupivacaine 0.25% will be injected.
SAPB block
Ultrasound-Guided Serratus Anterior Plane Block (SAPB) The probe will be placed on the mid-axillary line at the level of the fourth rib to visualize the serratus anterior and latissimus dorsi muscles. After establishing the correct level, the needle will be introduced in-plane. After puncturing the serratus muscle and contacting the rib, 40 mL of bupivacaine 0.25% will be deposited between the serratus muscle fascia and the rib periosteum, termed a deep serratus anterior plane block.
PIFB
Ultrasound-Guided PIFB Under complete aseptic technique with the patient in the supine position, a 6 to 13 MHz ultrasound linear transducer probe (Mindray, Shen zhen, China) will be placed 2 or 3 cm parallel to the long axis of the sternal bone to identify the second to fourth costal cartilages and targeting the fourth costal cartilage The needle will be inserted in-plane with the US probe, in a caudal-to-cranial direction. The needle will be advanced until the tip is positioned in the interfascial plane between the pectoralis major muscle and the intercostal muscle. After confirmation of the correct position of the tip of the needle, as shown by separation of the fascial layers on injecting 2 mL normal saline solution, 10 mL of bupivacaine 0.25% will be injected.
Eligibility Criteria
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Inclusion Criteria
* Age 18-65 years
* American Society of Anesthesiologists (ASA) physical state I-II
Exclusion Criteria
* Body Mass Index \> 30 kg/m2.
* Skin infection at the site of injection.
* History of renal, liver, cardiac, and neuropsychiatric disorder problems.
* Bleeding or coagulation abnormality.
* Known allergy to any drugs used in this study.
18 Years
65 Years
FEMALE
No
Sponsors
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Assiut University
OTHER
Responsible Party
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Mohammed Mahmoud Shaker Ahmed
Resident doctor at Anesthesia, Intensive Care and Pain Management
Principal Investigators
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Mohammad Mahmoud Shaker, Bachelor's
Role: PRINCIPAL_INVESTIGATOR
Assiut University
Locations
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Assiut University
Asyut, , Egypt
Countries
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References
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Misbah Mahmoud A., Said Ahmed A., Aly Salah A., Ahmed El-sayed N., Ali El Asser H., Mohamed Elsaed M. Ketamine Versus Dexmedetomidine as Adjuvants to Bupivacaine in Modified Pectoralis Plane Block for Analgesia in Patients Undergoing Modified Radical Mastectomy. Zagazig Univ Med J 2025.
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Hozien AI, Helmy AM, Koptan HM, Elfeil YE, Yakout MMS, Elwafa HBAA. Analgesic Effect of Addition of Pectointercostal Block to Serratus Anterior Plane Block in Breast Surgeries: A Randomized, Controlled Trial. Pain Physician. 2023 Oct;26(6):E679-E685.
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Other Identifiers
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PECB II & PIFB VS SAPB in MRM
Identifier Type: -
Identifier Source: org_study_id
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