الفهرس 
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Abstract
It has been observed that the majority of patients who had (MRM) surgery suffered
severe acute pain following surgery. Inadequate pain control has both psychological and
physiological consequences. Thus, post-operative pain control of MRM surgery is critical in
perioperative anesthetic care.
The Study aim:
Primary outcome: to compare the ESPB efficacy versus posterior SAPB approach as
regards control of postoperative pain in MRM by using the VAS during rest and movement.
Secondary outcomes: To compare total opioid consumption ,sensory level ,axillary
coverage and hemodynamic changes in the first 24 hours postoperatively. To compare the
patient satisfaction before discharge from the hospital in both groups and local or systemic
complications. Neuropathic pain will be assessed after one week and one moth
postoperatively.
The study began on June 1, 2020-2021 on 56 patients aged 20-60 years old (ASA-II)
scheduled for MRM at the MRI Hospital; Alexandria University after acquiring authorization
from the Medical Research Institute (MRI) Ethical Committee and obtaining signed informed
consent from each patient.
Patients will be randomly assigned to one of two groups.
group I: SAPB (posterior approach): 28 female patients were blocked with the
administration 20 mL of 0.25% bupivacaine and 8 mg dexamethasone.
group II: ESPB: 28 female patients were blocked with the administration of 20 ml of
0.25% bupivacaine and 8 mg dexamethasone.
A randomized controlled trial (RCT) is used in this investigation.
Findings:
Demographic features (age, weight, height and BMI) showed no significant difference
statistically (p= 0.321, p=0.191, p=0.311 and p=0.663 respectively). HR and the MABP
before and twenty minutes after injection and intraoperatively and postoperatively together
with postoperative oxygen saturations percentage changes, total opioid consumption,
neuropathic pain, VAS, postoperative shoulder pain, patient satisfaction and recorded
complications showed a difference with no significance statistically between both involved
groups. ESPB showed an increase with statistical significance in the sensory level (number of
dermatomes) (p= 0.031).