الفهرس 
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Abstract
Breast cancer is the most common cancer in women both in 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 interfascial plane blocks have been described. Pec I block involves a hydrodissection of the plane between the pectoral muscles with local anesthetic to block the lateral and medial pectoral nerves, 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 pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) 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 64 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 32 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB).
The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the numeric rating score system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic 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 according to demographic data.
Also, there was a statistically significant decrease mean of group II compared to group I according to postoperative systolic blood pressure (mmHg) from 1hr. to 6hrs.
While there was no statistically significant difference between groups according to postoperative diastolic blood pressure (mmHg).
However, a statistically significant decrease mean of group II compared to group I according to postoperative heart rate (beat/min) from 1hr. to 6hrs was found.
A statistically significant decrease mean of group II compared to group I according to numeric rating score for pain from 1hr to after 6hrs also was found.
The current study shows highly statistically significant difference between groups according to time of first analgesia (hour), number of patients who received postoperative Diclofenac 75mg and total consumption of Diclofenac 75mg.