Pectoral Nerve Block Versus Serratus Posterior Superior Intercostal Plane Block for Pain Control After Mastectomy (PECS-SPSIPB)

Comparison of the Effects of Pectoral Nerve Block and Serratus Posterior Superior Intercostal Plane Block on Acute and Persistent Postoperative Pain After Mastectomy: A Prospective, Double-Blind, Randomized Controlled Trial

This study compares two ultrasound-guided nerve block techniques for pain control after mastectomy for breast cancer: the pectoral nerve block (PECS II) and the serratus posterior superior intercostal plane (SPSIP) block. Both techniques involve injecting local anesthetic near nerves supplying the surgical area.

The study will include 78 adults aged 18 to 85 years undergoing elective mastectomy under general anesthesia. Participants will be randomly assigned to receive one of the two blocks before surgery. Both groups will receive postoperative pain treatment, including a patient-controlled device that delivers tramadol when needed.

The main aim is to compare postoperative opioid consumption. The study will also assess pain at rest and during movement, the need for additional pain medication, side effects, recovery quality, and persistent pain. Pain scores and tramadol consumption will be recorded at 0, 2, 4, 8, 16, and 24 hours after surgery. Recovery quality will be assessed at 24 hours, and persistent pain will be assessed by telephone at 3 months.

Study Overview

• Status: Recruiting
• Conditions: Breast Cancer; Postoperative Pain; Persistent Postsurgical Pain
• Intervention / Treatment: Other: Ultrasound-Guided Serratus Posterior Superior Intercostal Plane Block; Other: Ultrasound-Guided Pectoral Nerve Block Type II

Detailed Description

This prospective, randomized study will be conducted at Bursa City Hospital in adults undergoing elective mastectomy for breast cancer. Participants will be assigned to an ultrasound-guided serratus posterior superior intercostal plane (SPSIP) block or a pectoral nerve block (PECS II) using a computer-generated randomization sequence.

Both blocks will be performed before induction of general anesthesia. The SPSIP group will receive 30 mL of 0.25% bupivacaine in the fascial plane between the serratus posterior superior and intercostal muscles at the third rib. The PECS II group will receive 10 mL of 0.25% bupivacaine between the pectoralis major and pectoralis minor muscles and 20 mL between the pectoralis minor and serratus anterior muscles.

General anesthesia and postoperative multimodal analgesia will be standardized. On arrival in the recovery room, participants will receive intravenous patient-controlled analgesia with tramadol at a concentration of 5 mg/mL, a bolus dose of 10 mg, a lockout interval of 20 minutes, and no basal infusion. Intravenous meperidine at 0.5 mg/kg will be administered as rescue analgesia when the Numeric Rating Scale (NRS) score is 4 or higher.

Postoperative pain and opioid consumption will be assessed by an anesthesiologist who is unaware of group allocation. The clinician performing the block will know the assigned technique and will not collect postoperative outcome data.

NRS scores at rest and during movement will be recorded at 0, 2, 4, 8, 16, and 24 hours after surgery. The scale ranges from 0 (no pain) to 10 (the worst pain imaginable). Tramadol consumption will be recorded at the same time points. Rescue analgesic requirements, time to first rescue analgesia, time to first postoperative mobilization, length of hospital stay, adverse effects, and block-related complications will also be recorded.

Quality of recovery will be assessed using the Quality of Recovery-15 questionnaire at 24 hours after surgery. Postoperative nausea and vomiting will be monitored during the first 24 hours. Persistent postoperative pain will be assessed at 3 months using the McGill Pain Questionnaire during a telephone interview conducted with prior participant consent.

• Study Type: Interventional
• Enrollment (Estimated): 78
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Enes Batuhan Cansız, MD; Phone Number: 05384600660; Email: enbatuca55@gmail.com

Study Locations

• Turkey (Türkiye)
  • Bursa
    • Nilufer, Bursa, Turkey (Türkiye), 16110
      • Recruiting
      • Bursa City Hospital
      • Contact: emre ulusoy; Phone Number: 05379492799; Email: emreulusoy36@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Age between 18 and 85 years.
• Scheduled for elective mastectomy for breast cancer under general anesthesia.
• American Society of Anesthesiologists (ASA) physical status I, II, or III.
• Willingness to participate in the study and provide informed consent.

Exclusion Criteria:

• Refusal to participate in the study.
• History of bleeding diathesis or coagulopathy.
• Receiving anticoagulant therapy.
• Allergy or hypersensitivity to local anesthetics or opioid medications.
• History of local anesthetic toxicity.
• Infection at the planned block injection site.
• Hepatic or renal failure.
• Uncontrolled diabetes mellitus.
• Uncontrolled hypertension.
• Intellectual disability.
• Receiving opioid treatment for chronic pain.
• Pregnancy, suspected pregnancy, or breastfeeding.
• Planned bilateral mastectomy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Serratus Posterior Superior Intercostal Plane Block (SPSIP); Participants will receive an ultrasound-guided SPSIP block on the surgical side before induction of general anesthesia. With the participant seated, 30 mL of 0.25% bupivacaine with epinephrine will be injected into the fascial plane between the serratus posterior superior and intercostal muscles at the third rib. Participants will also receive standardized general anesthesia and postoperative multimodal analgesia, including patient-controlled intravenous tramadol and rescue analgesia when required.	Other: Ultrasound-Guided Serratus Posterior Superior Intercostal Plane Block; A single ultrasound-guided block will be performed on the surgical side before induction of general anesthesia. With the participant seated and the hand on the opposite shoulder, a high-frequency linear ultrasound probe will be positioned along the medial scapular border to identify the third rib and serratus posterior superior muscle. A 50-mm block needle will be advanced in-plane in a caudal-to-cranial direction. After confirming the plane with 5 mL of saline, 30 mL of 0.25% bupivacaine with epinephrine will be injected between the serratus posterior superior and intercostal muscles.; Other Names: SPSIP Block
Active Comparator: Pectoral Nerve Block (PECS II); Participants will receive an ultrasound-guided PECS II block on the surgical side before induction of general anesthesia. With the participant supine, 10 mL of 0.25% bupivacaine with epinephrine will be injected between the pectoralis major and pectoralis minor muscles, followed by 20 mL between the pectoralis minor and serratus anterior muscles. Participants will also receive standardized general anesthesia and postoperative multimodal analgesia, including patient-controlled intravenous tramadol and rescue analgesia when required.	Other: Ultrasound-Guided Pectoral Nerve Block Type II; A single ultrasound-guided PECS II block will be performed on the surgical side before induction of general anesthesia, with the participant supine. A high-frequency linear ultrasound probe will be used to identify the pectoralis major, pectoralis minor, and serratus anterior muscles. A 50-mm block needle will be advanced using an in-plane approach. After confirming each injection plane with 5 mL of saline, 10 mL of 0.25% bupivacaine with epinephrine will be injected between pectoralis major and pectoralis minor, followed by 20 mL of the same solution between pectoralis minor and serratus anterior.; Other Names: PECS II Block

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Opioid Consumption	Postoperative opioid consumption will be compared between the groups. Tramadol consumption administered through intravenous patient-controlled analgesia will be recorded in milligrams at 0, 2, 4, 8, 16, and 24 hours postoperatively. The total dose of rescue meperidine will be recorded separately.	First 24 hours postoperatively, with recordings at 0, 2, 4, 8, 16, and 24 hours.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity at Rest	Pain intensity at rest will be assessed using the Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (the worst pain imaginable). Higher scores indicate greater pain intensity.	At 0, 2, 4, 8, 16, and 24 hours postoperatively.
Pain Intensity During Movement	Pain intensity during movement will be assessed using the Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (the worst pain imaginable). Higher scores indicate greater pain intensity.	At 0, 2, 4, 8, 16, and 24 hours postoperatively.
Total Rescue Analgesic Dose	The total dose of intravenous meperidine administered as rescue analgesia will be recorded in milligrams. Meperidine at 0.5 mg/kg will be administered when the Numeric Rating Scale score is 4 or higher.	During the first 24 hours postoperatively.
Time to First Rescue Analgesia	The time of the first postoperative administration of rescue analgesia will be recorded. Intravenous meperidine at 0.5 mg/kg will be administered when the Numeric Rating Scale score is 4 or higher.	During the first 24 hours postoperatively.
Quality of Recovery-15 Score	Quality of postoperative recovery will be assessed using the Quality of Recovery-15 (QoR-15) questionnaire. The questionnaire contains 15 items, with a total score ranging from 0 to 150. Higher scores indicate better quality of recovery.	At 24 hours postoperatively.
Postoperative Nausea and Vomiting	Postoperative nausea and vomiting will be assessed using a four-category scale: 1 = no nausea or vomiting; 2 = nausea without vomiting; 3 = one episode of vomiting or persistent nausea; and 4 = two or more episodes of vomiting or severe/persistent retching. Higher scores indicate more severe symptoms.	During the first 24 hours postoperatively.
Persistent Postoperative Pain Assessed Using the McGill Pain Questionnaire	Persistent postoperative pain will be assessed using the McGill Pain Questionnaire during a telephone interview at 3 months after surgery. Participants will provide prior consent for telephone follow-up.	At 3 months postoperatively.

Collaborators and Investigators

• Sponsor: Bursa City Hospital
• Collaborators: Ulusoy, Emre, M.D.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2026
• Primary Completion (Estimated): June 15, 2027
• Study Completion (Estimated): June 15, 2027

Study Registration Dates

• First Submitted: November 5, 2026
• First Submitted That Met QC Criteria: November 5, 2026
• First Posted (Actual): November 10, 2026

Study Record Updates

• Last Update Posted (Actual): November 10, 2026
• Last Update Submitted That Met QC Criteria: November 5, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Keywords: Mastectomy; Pectoral Nerve Block; PECS II Block; SPSIP Block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Neoplasms by Site; Neoplasms; Skin Diseases; Breast Diseases; Pathological Conditions, Signs and Symptoms; Skin and Connective Tissue Diseases; Signs and Symptoms; Pain, Postoperative; Breast Neoplasms
• Other Study ID Numbers: BSH001

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No