الفهرس 
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Abstract
Modified radical mastectomy is the most common surgical procedure for operable breast malignancies. Following mastectomy, the patients are emotionally disturbed apart from the physical suffering. Various strategies like non-steroidal anti-inflammatory drugs, opioids, peripheral nerve blocks, wound infiltration with local anaesthetics, wherever possible were found to have significantly improved the postoperative pain.
Despite these improvements, several studies reported that limited success in providing effective postoperative pain control. The technique of infiltration or irrigation of local anaesthetic is widely used as a part of multimodal analgesia in plastic reconstructive breast surgery, with remarkable effectiveness and without adverse effects.
Infiltration of local anaesthetic along the line of incision is not recommended in malignant lesions, because of the fear of needle track seedlings and cutaneous spread of malignancy. Moreover, the tissue dissection extends beyond the surgical incision. Infiltration along the line of surgical incision may not provide adequate analgesia.
Aim
The study aimed to compare the quality of postoperative Analgesia following MRM using ketamine as an adjuvant to local anaesthetic in PECS block versus by local instillation into the surgical wound.
Patients and Methods
A total 60 women were scheduled for MRM were enrolled in the study. Those patients were randomly subdivided into either PECS group (30 women received ultrasound guided, modified PECS block) or local instillation group (30 women received instillation of 1 mg/kg ketamine HCL plus 30 mL of 0.25% bupivacaine HCL in the surgical field).
Postoperative hemodynamics assessments and NRS were during till the 48th. In addition to time to 1st analgesic request and total consumption of morphine were recorded. Patients were also, evaluated for side effects.
Main findings
Local instillation procedure required significantly shorter to be done in comparison to PECS procedure (12 ± 2.92 vs. 1.70 ± 0.54 (minute); p< 0.001), 2) both techniques had comparable hemodynamics parameters postoperatively, and 3) pain score, first analgesic request and total consumption of morphine were comparable in both groups.
Both studied groups had insignificant differences as regard frequency of side effects where majority (63.3% of PECS group and 70% of topical instillation group) of both groups reported no side effects. Eleven (36.7%) patients in PECS group and 7 (23.3%) patients of topical instillation group suffered from vomiting. Sedation effect was reported in only two patients underwent topical instillation.