Combined Pectoserratus and Superficial Cervical Plexus Block Versus Local Infiltration for Chemoport Implantation

Effectiveness of Combined Pectoserratus Plane (PSP) and Superficial Cervical Plexus (SCP) Blocks Compared With Local Infiltration Anesthesia for Chemoport Implantation in Cancer Patients Undergoing Sedation

Chemoport implantation is frequently performed in patients with cancer requiring long-term intravenous chemotherapy. Local infiltration anesthesia (LIA) remains the conventional anesthetic technique for this procedure. However, it often provides incomplete analgesia because sensory innervation of the anterior chest wall originates from multiple neural pathways. Consequently, patients may experience pain during the surgery, necessitating additional intraoperative opioid administration.

Ultrasound-guided regional anesthesia has emerged as an effective alternative for chest wall procedures. The combined pectoserratus plane (PSP) block and superficial cervical plexus (SCP) block provides broader sensory coverage of the anterior chest wall involved in chemoport implantation. This combined technique has the potential to improve intraoperative analgesia, reduce opioid consumption, decrease postoperative pain, and enhance postoperative recovery while maintaining procedural safety.

This prospective, single-blind, randomized controlled trial aims to compare the effectiveness of ultrasound-guided combined PSP and SCP block with conventional local infiltration anesthesia in adult cancer patients undergoing chemoport implantation under intravenous sedation. Participants will be randomly allocated in a 1:1 ratio to receive either combined PSP-SCP block or LIA. All participants will receive standardized sedation using dexmedetomidine.

The primary outcome is intraoperative additional opioid requirement. Secondary outcomes included postoperative pain intensity, postoperative additional NSAID requirements, patient satisfaction, and procedure-related complications.

The findings of this study are expected to provide evidence regarding the role of combined ultrasound-guided fascial plane blocks as an alternative anesthetic technique for chemoport implantation in cancer patients.

Inclusion Criteria:

• Aged 18-65 years.
• Diagnosed with cancer requiring elective chemoport implantation for long-term intravenous therapy.
• Classified as American Society of Anesthesiologists (ASA) Physical Status II or III.
• Scheduled to undergo chemoport implantation under intravenous sedation.
• Able to understand the study procedures and provide written informed consent.

Exclusion Criteria:

• Refusal to participate in the study.
• History of burns or infection at the chest wall in the planned injection area.
• Presence of a tumor involving the chest wall at the planned injection site.
• Known allergy or hypersensitivity to local anesthetic agents.
• Obesity, defined as a body mass index (BMI) >30 kg/m².
• Severe coagulation disorders, defined as a platelet count <50,000/µL or prolonged prothrombin time (PT) and/or activated partial thromboplastin time (aPTT) greater than twice the upper limit of normal.