TPVB, PECSB, ESPB for Postmastectmy Pain

Study Overview
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Brief Summary
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Aim of the work The aim of the study is to compare between the effects of ultrasound guided thoracic paravertebral block, pectoral nerve block II, and erector spinae block in management of pain during cancer breast surgeries. The hypothesis of the study is that the three groups will give comparative results.

Official Title
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A Comparative Study Between Ultrasound-guided Thoracic Paravertebral Block, Pectoral Nerves Block, and Erector Spinae Block for Pain Management in Cancer Breast Surgeries. A Randomized Controlled Study

Conditions
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Pain, Postoperative

Intervention / Treatment
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* Procedure: Ultrasound guided block
* Drug: IV morphine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA physical status classification class I or II Age group 18 - 60 years of the female gender Patients undergoing breast cancer surgeries Exclusion Criteria: Patient refusal History of hypersensitivity to local anesthetics Bleeding disorders or patients receiving anticoagulants Spine or chest wall deformities Pregnancy Local infection at the site of injection.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Control Group (D)<br>Patient will receive opioid only for management of their perioperative pain | Drug: IV morphine<br>* given when VAS>3<br>|
| Active Comparator: Paravertebral block Group (A)<br>Will receive thoracic paravertebral block | Procedure: Ultrasound guided block<br>* Giving one regional block<br>* Other names: Us guided PECs 1 and 2;Drug: IV morphine<br>* given when VAS>3<br>|
| Active Comparator: Pectoral block Group (B)<br>Will receive pectoral 1 and 2 block | Procedure: Ultrasound guided block<br>* Giving one regional block<br>* Other names: Us guided PECs 1 and 2;Drug: IV morphine<br>* given when VAS>3<br>|
| Active Comparator: Erector spinae block Group (C)<br>Will receive erector spinae block | Procedure: Ultrasound guided block<br>* Giving one regional block<br>* Other names: Us guided PECs 1 and 2;Drug: IV morphine<br>* given when VAS>3<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome of the study will be duration of analgesia (time to first rescue analgesia after administration of the block). | minutes | 0-24o minutess | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain | assessed by VAS score (0-10) where 0=no pain and 10=worst pain | 48 hours | 
| Total morphine consumption | recorded postoperatively in mg | 48 hours | 
| Postoperative nausea and vomiting (PONV) | 4 points score of PONV (0-3) where 0=no PONV and 3=vomiting more than once | 48 hours |