Background: Breast surgery is an exceedingly common procedure with an increased incidence
of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to
neuro-axial and paravertebral blocks for ambulatory breast surgeries.
Objectives: This study aims to compare the analgesic efficacy and safety of modified Pecs
block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer
surgery.
Study Design: A randomized, double-blind, prospective study.
Setting: Academic medical center.
Methods: This study is registered at www.clinicaltrials.gov under number: (NCT02620371)
after approval by the ethics committee of South Egypt Cancer Institute, Assuit University,
Assuit, Egypt. Sixty patients aged 18 – 60 years scheduled for modified radical mastectomy
were enrolled and randomly assigned into 2 groups (30 patients each):
Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25%
bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block with 30
mL of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). Patients were followed up
for 48 hours postoperatively for vital signs, VAS score, first request of rescue analgesia and total
morphine consumption, sedation score, and side effects.
Results: Ketamine plus bupivacaine in Pecs block compared to bupivacaine alone prolonged
the mean time of first request of analgesia (18.25 ± 1.98), (12.56 ± 2.64), respectively (P <
0.001), reduced total morphine consumption (12.50 ± 4.63), (18.86 ± 6.28), respectively (P =
0.016). With no significant difference in hemodynamics, respiratory rate, oxygen saturation,
VAS and sedation scores, and side effects observed between the 2 groups (P > 0.05).
Limitations: This study is limited by its sample size.
Conclusion: The addition of ketamine to modified Pecs block prolonged the time to first
request of analgesia and reduced total opioid consumption without serious side effects in
patients who underwent a modified radical mastectomy.