الفهرس 
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Abstract
Breast cancer is the most common cancer in women in both the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women.
A procedure called Modified radical mastectomy is now a standard surgical treatment for early stage breast cancers. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases.
Though various risk factors have been suggested, inappropriate acute postoperative pain management has been associated with the development of chronic post-mastectomy pain, a complex post-surgical pain syndrome that may occur following any type of breast surgery.
After the application of ultrasound in anesthetic practice, several interfacial plane blocks have been described. The Modified Pecs which include Pecs I block involves a hydrodissection of the plane between the pectoral muscles with local anesthetic to block the lateral and medial pectoral nerves, and Pecs II nerve block which is an extension that involves a second injection lateral to the Pecs I injection point in the plane between the pectoralis minor and serratus anterior muscles with the intention of providing blockade of the upper intercostal nerves(T3-T6).
Serratus anterior plane blocks performed at the axillary fossa, in which the intercostobrachialis nerve, lateral cutaneous branches of the intercostal nerves (T3–T9), long thoracic nerve, and thoracodorsal nerve are located in a compartment between the serratus anterior and the latissimus dorsi muscles, between the posterior and midaxillary lines (Blanco, 2011).
The aim of this work is to evaluate the effectiveness of ultrasound guided Modified pectoral nerve block versus Serratus Anterior plane block for postoperative Analgesia in modified radical mastectomy.
After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 70 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 35 patients; group I patients received Modified PECS, group II patients received Serratus Anterior Plane Block (SAPB).
The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic requirement, the numeric rating score system, time for first for analgesic need and total consumption of opioid in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed.
The results of our study showed that there was no statistically significant difference between groups regarding demographic data.
Also, there was a statistically significant decrease in Mean blood pressure (mmHg) in group II compared with group I from 1hr. to 6hrs postoperative.
However, a statistically significant decrease in group II compared to group I regarding postoperative heart rate (beat/min) from 1hr. to 6hrs.
A statistically significant decrease in group II compared to group I regarding numeric rating score for pain from 1hr to after 6hrs also was found.
The current study shows highly statistically significant difference between the two groups as regard the time of first analgesic requirements (hour) which is longer in SAPB , number of patients who received postoperative diclofenac 75mg which are more in PECII block and total dose of opioids during the first 24 hrs which is larger in PECII block.