Effectiveness of Regional Blocks for Postoperative Pain Control and Recovery in Breast Cancer Surgery in a...

Background and aims Effective postoperative pain management after breast cancer surgery is essential to enhance recovery, minimise opioid use, and prevent chronic post-surgical pain. In low- and middle-income countries (LMICs) like Sri Lanka, limited access to ultrasound and trained personnel often restricts the use of regional anaesthesia (RA). Although regional anaesthesia (RA) is well-established for breast cancer surgery, evidence from low- and middle-income countries remains limited. This study evaluated the effectiveness and feasibility of ultrasound-guided regional nerve blocks in improving postoperative outcomes in a resource-limited healthcare setting. Material and methods A prospective observational study was conducted at the Surgical Oncology Unit, Teaching Hospital Anuradhapura, from October 2023 to February 2024. Fifty-six female patients undergoing major breast cancer surgery under general anaesthesia were allocated to receive either regional anaesthesia (paravertebral, erector spinae, or pectoral nerve block) or local wound infiltration. Forty-one (73.2%) received ultrasound-guided regional blocks (paravertebral (n = 16), erector spinae plane (ESP) (n = 13), or pectoral nerve (PECS I/II) blocks (n = 12)) and fifteen (26.8%) received local anaesthetic infiltration. Pain scores were assessed using the visual analogue scale (VAS) at defined postoperative intervals. Morphine consumption, postoperative nausea and vomiting (PONV), mobilisation time, and three-month chronic pain were compared using independent-samples t-tests and chi-square/Fisher's exact tests, with p < 0.05 considered significant. Results Patients receiving regional anaesthesia (RA) reported significantly lower postoperative pain scores at 4 hours (2.5 ± 1.9 versus 4.7 ± 1.9; p = 0.001), 6 hours (1.9 ± 1.3 versus 3.2 ± 1.5; p = 0.003), and 12 hours (1.4 ± 0.8 versus 2.6 ± 1.5; p = 0.009) compared with the local infiltration group. By 24 hours, pain scores were low and comparable between groups. Mean morphine consumption was significantly lower in the RA group (2.6 ± 5.8 mg versus 7.5 ± 3.6 mg; p = 0.004), and 71% of RA patients required no opioids postoperatively. The incidence of postoperative nausea and vomiting (PONV) was also reduced (mean score: 1.2 ± 0.4 versus 1.7 ± 0.5; p < 0.001). Patients who received RA achieved earlier mobilisation (6.0 ± 1.5 hours versus 7.0 ± 1.4 hours; p = 0.032), and none developed chronic pain at three months, compared with 40% in the infiltration group (p = 0.009). No block-related complications were observed. Conclusions Regional anaesthesia techniques provided superior postoperative analgesia, markedly reduced opioid and antiemetic requirements, and facilitated earlier mobilisation following breast cancer surgery in a resource-limited setting. These blocks were feasible, safe, and highly effective despite infrastructural constraints. Incorporating regional anaesthesia into multimodal analgesia protocols in low- and middle-income countries may substantially improve recovery, enhance patient satisfaction, and reduce the burden of chronic post-mastectomy pain.