Pectoral nerve blocks and quality of recovery following breast surgery

INTERVENTION: Ultrasound‐guided pectoral nerve block (Pecs 2) with ropivacaine 0.475% 0.2ml/kg in the plane between pectoralis major and minor AND ropivacaine 0.475% 0.25ml/kg in the plane deep to pectoralis minor will be injected by anaesthetist prior to general anaesthesia, in addition to standardised general anaesthesia. Identical volume of 0.9% sodium chloride (normal saline) infiltrated subcutaneously by surgeons at wound edges prior to wound closure. Adherence is ensured by Pecs 2 block being performed by anaesthetists trained in Pecs 2 block. Surgeons will be notified of the protocol for wound infiltration. CONDITION: Post surgical pain Post surgical quality of recovery PRIMARY OUTCOME: Quality of recovery score 15 (QoR15) SECONDARY OUTCOME: Adverse effects e.g. nausea and vomiting, use of antiemetics. Outcome is assessed by review of medical records and question nausea and vomiting will be assessed as part of the QoR15 Brief Pain Inventory Score Oral morphine equivalents ‐ outcome is assessed by review of medical records. INCLUSION CRITERIA: Adult female patients undergoing elective unilateral breast surgery [unilateral wide local excision WLE with or without sentinal lymph node biopsy, axillary clearance/dissection and unilateral mastectomy], American Society of Anesthesiologists (ASA) score I to III