This prospective randomized study will compare the effects of Erector Spinae Plane Block (ESPB) and Serratus Anterior Plane Block combined with Pectoral Nerve Block Type II (SAPB + PECS II) on intraoperative analgesia and postoperative opioid consumption in patients undergoing breast cancer surgery. Seventy patients (ASA I-III, aged 18-75 years) will be randomized into two groups using the sealed envelope method. Ultrasound-guided blocks will be performed preoperatively by the same anesthesiologist, with Group 1 receiving ESPB and Group 2 receiving a combined SAPB + PECS II technique performed through a single skin puncture (single needle entry site) with sequential injections into the two target fascial planes. All patients will undergo surgery under general anesthesia and receive postoperative analgesia via morphine patient-controlled analgesia. Pain scores and total opioid consumption will be statistically analyzed, with p \< 0.05 considered significant.
Age between 18 and 75 years
ASA physical status I-III
No history of bleeding or coagulation disorders
Absence of neuropathy
systemic or regional infection
known allergy to local anesthetics
Unwillingness to participate in the study
Parallel
SAPB + PECS II Technique
Procedure/SurgeryInvestigators will perform both blocks with a single injection.
Erector Spinae Plane Block
Procedure/SurgeryInvestigators will perform the block before the patient receives general anesthesia and investigators will check it with the pinprick test.
the Numerical Rating Scale
The Numerical Rating Scale is a subjective pain assessment tool in which patients rate their pain intensity on a scale from 0 to 10, where 0 indicates no pain (the best/most favorable score) and 10 represents the worst pain imaginable (the worst/least favorable score)
Nausea and Vomiting Scale
Nausea and vomiting were assessed using the Nausea and Vomiting Scale, scored between 0 and 4 (0 = no symptoms \[best/most favorable score\], 1 = mild nausea, 2 = moderate nausea, 3 = frequent vomiting, approximately four episodes, 4 = continuous vomiting \[worst/least favorable score\]).
Apfel Risk Score
The Apfel Risk Score is a simplified risk assessment tool used to predict postoperative nausea and vomiting (PONV). It consists of four independent risk factors: female gender, non-smoking status, history of PONV or motion sickness, and planned postoperative opioid use. The risk of PONV increases proportionally with the number of risk factors present.
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