Enhancing Postoperative Analgesia in Breast Reduction Surgery: The Combined Effect of Pectointercostal Fascial Plane Block and Serratus Anterior Plane Block.

[BACKGROUND] Pectointercostal Fascial Plane Block (PIFB) targets the anterior cutaneous branches of the intercostal nerves and provides analgesia to the anteromedial chest wall. In this study, we aimed to evaluate the effect of PIFB in addition to Serratus Anterior Plane Block (SAPB) on postoperative morphine consumption and pain scores in breast reduction surgery.

[MATERIALS AND METHODS] Sixty-four ASA I-II patients (≥18 years) were randomly assigned to two groups. General anesthesia was induced with propofol, rocuronium, fentanyl, and maintained with sevoflurane and remifentanil. After intubation: Group I (PIFB + SAPB) received bilateral PIFB (15 mL 0.25% bupivacaine) and SAPB (20 mL 0.25% bupivacaine). Group II (SAPB only) received SAPB (20 mL 0.25% bupivacaine) only. Postoperative analgesia included IV morphine patient-controlled analgesia (1 mg bolus, 10-min lockout, 4-hour limit: 10 mg). Outcomes measured were stay in postanesthesia care unit time (PACU), 24-hour morphine consumption, morphine demands, VAS scores (rest and movement), additional analgesic use, and complications.

[RESULTS] Both groups had similar demographics, surgical duration, and PACU stay. 24-hour morphine consumption was lower in Group I (3.7±2.2 mg vs. 7.9±2.3 mg, p<0.05). Morphine demands were lower in Group I (4.5±2.7 vs. 10.4±3.7, p<0.05). VAS scores (rest and movement) were lower in Group I (p<0.05). Rescue analgesic requirement was lower in Group I than in Group I (p=0.01). No complications occurred in both groups.

[CONCLUSION] PIFB combined with SAPB significantly reduces morphine consumption and pain scores in breast reduction surgery without complications.

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