Dexamethasone Enhances PECS Block Analgesia in Post-Mastectomy Patients: Suggests Study

With approximately 40% of breast surgery patients experiencing moderate-to-severe postoperative pain, Dr. Shubhi Kapuskar and colleagues from Gandhi Medical College, Bhopal, investigated a clinical gap in current regional techniques by building on Blanco’s pectoral nerve block research to determine if a dexamethasone-bupivacaine combination could provide superior, sustained analgesia. The study aims to optimize transitional pain services (TPS) by mitigating the transition from acute to chronic pain through a more effective multimodal analgesic regimen.

Therefore, the prospective, double-blind, randomized trial conducted at Gandhi Medical College involved 60 patients undergoing elective modified radical mastectomy (MRM) to compare the efficacy of ultrasound-guided pectoral nerve (PECS) blocks using bupivacaine with or without 8 mg of dexamethasone. Excluding those with systemic diseases or coagulopathies, the researchers evaluated primary outcomes including the duration of analgesia and total rescue tramadol consumption to determine the block's impact on postoperative pain.

Key Clinical Findings of the Study Include:

• Prolonged Pain Relief: The study credited the dexamethasone addition with significantly extending the mean time to first rescue analgesia to 462.33 minutes, compared to only 378.67 minutes for those receiving bupivacaine alone (P < 0.001).

• Reduced Opioid Dependence: A major takeaway for clinicians was the dramatic reduction in total 24-hour tramadol consumption, which dropped to 35.83 mg in the dexamethasone group from 72.50 mg in the control group (P < 0.001).

• Consistent Analgesic Efficacy: Patients in the dexamethasone cohort demonstrated significantly lower Numeric Rating Scale (NRS) scores at every assessment interval, including 4, 8, 12, and 24 hours post-block (P < 0.001).

• Hemodynamic Safety: Despite the more potent analgesic effect, both groups displayed remarkably similar and stable hemodynamic profiles, including heart rate and blood pressure, throughout the perioperative period.

• Comparable Adverse Events: The incidence of complications such as pneumothorax remained very low and statistically similar between the groups, suggesting that dexamethasone enhances efficacy without compromising safety (P>0.05).

The results suggest that integrating 8 mg of dexamethasone into bupivacaine for PECS blocks significantly optimizes perioperative care by providing effective relief and prolonging the analgesic window by roughly 83 minutes. This combination provides a viable, safe alternative to conventional techniques, potentially lowering the risk of long-term pain syndromes.

Thus, the trial concludes that clinicians might consider adopting this augmented nerve block technique as a core component of transitional pain services to improve patient satisfaction and long-term recovery outcomes.

While the study was limited to healthier patients without prior neoadjuvant therapy and lacked a detailed assessment of sensory block duration, future research exploring comprehensive sensory characteristics could further refine this promising pain management strategy.

Reference

Kapuskar S, Gupta V, Kubre J, Mehrotra S. Beyond acute analgesia: Evaluating the role of PECS block with dexamethasone in transitional pain services and chronic postmastectomy pain prevention. Indian J Pain 2026;40:15‑9.