Comparing the quality of analgesia with ultrasound-guided pectoral nerve block and serratus anterior plane block II in patients undergoing modified radical mastectomy: a randomised clinical trial (original) (raw)
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Curēus, 2024
Background: Breast carcinoma is one of the most common cancers in present-day women worldwide, hence surgical intervention for the same is inevitable. General anesthesia being the preferred technique, the selection of appropriate postoperative pain management is a major concern in which superficial fascial plane chest wall blocks play a pivotal role. We aimed to prove the efficacy of peripheral nerve stimulatorguided pectoral nerve-1 (PEC 1) block and serratus anterior plane (SAP) block for postoperative analgesia in modified radical mastectomy. Methods: This prospective randomized controlled clinical study comprised 60 females undergoing modified radical mastectomy and was randomly allocated to two groups. Group A patients received general anesthesia while, in addition to general anesthesia, group B patients received PEC 1 and SAP blocks. Postoperatively the active and passive visual analog score (VAS), duration of analgesia, cumulative requirement of rescue analgesics in the first 24 hours and associated perioperative complications were noted. All quantitative data were analyzed by student t-test and qualitative data by chi-square test using MedCalc software 12.5. Results: VAS score for first 24 hours in group B was lower at rest, on pressure over the surgical site as well as on movements compared with the patients in group A with the p-value being < 0.0001 at all time intervals. Time for receiving first rescue analgesia was shorter (1.25±0.56hour vs 20.05±7.78hour, p<0.001) with the significantly higher requirement of cumulative doses of tramadol in the first 24 hours in patients belonging to group A (233.33±47.95mg vs 110±31.62 mg, p<0.001). Conclusion: PEC 1 and SAP blocks given under peripheral nerve stimulator guidance have a high success rate and are reliable in providing adequate postoperative analgesia for patients undergoing modified radical mastectomy.
2021
Objective: To find the effectiveness of ultrasound guided modified pectoral nerve block (PECS II) versus conventional analgesics for post-operative pain relief in women undergoing modified radical mastectomy. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anaesthesia, Pak Emirates Military Hospital Rawalpindi Pakistan, from May 2018 to Oct 2019. Methodology: A total of 74 adult female patients scheduled for elective unilateral modified radical mastectomy under general anaesthesia were randomized into two groups, pectoral nerve block II (P) group (n=37) and control (C) group (n=37). An ultrasound-guided pectoral nerve block II block was performed using 30 ml of 0.25% Bupivacaine in pectoral nerve block II group after induction of general anaesthesia. In control group (C), patients received only general anaesthesia. Primary outcome measure was opioid consumption in first 24 hours, and the secondary outcome was pain at the breast and axillary region ...
Bali Journal of Anesthesiology, 2019
Background: Inadequate acute postoperative pain management is the main risk factor for chronic pain after breast surgery. Pectoralis blocks I and II (pecs block I and II) are novels peripheral nerves block techniques introduced since 2011 by Blanco et al. Methods: Ten patients diagnosed with breast cancer planned for modified radical mastectomy (MRM), from preoperative evaluation patients with a physical status of American Society of Anesthesiologist (ASA) I and II. Anesthesia management under general anesthesia with an endotracheal tube and we performed PECS block II after general anesthesia. We recorded the systolic blood pressure, mean arterial pressure (MAP), and heart rate intraoperatively, and the pain scale at 4th, 6th, 12th, and 24th hours postoperatively. Results: The pain scale at 4th and 6th hours postoperatively were 0.3±0.5 and 0.6±0.5 respectively. The pain scale at resting starts to increase at the 12th and 24th hours (1.2±0.4 and 1.1±0.6). The mean total use of morphine recorded on PCA was 3.3 ± 0.9 (mg). No pecs block II complications were recorded in this study. Conclusion: Pecs block II is a relatively easy, safe, and effective for MRM surgeries. Further larger and double-blinded studies are needed to know its effectiveness compared to other techniques available.
Ain-Shams Journal of Anesthesiology, 2022
Background The primary goal of modified radical mastectomy is to remove cancerous cells and reduce the risk of breast cancer spreading. This operation is associated with considerable acute postoperative pain and restricted shoulder movement. If this acute pain is neglected most patients will develop chronic post-mastectomy pain, which reduces the quality of life. Regional anesthesia using ultrasound-guided paravertebral nerve block or pectoral nerve block has become an ideal addition to general anesthesia for providing analgesia after breast cancer surgery. This was a randomized clinical trial conducted between February 2018 and February 2019. This study compared between the two nerve blocks regarding the efficacy in terms of analgesic consumption. Results The study included 30 female patients who were undergoing modified radical mastectomy under general anesthesia and randomly divided into 2 groups of 15 patients in each. This study showed there was a statistically significant incr...
Korean Journal of Anesthesiology, 2020
Background: Regional nerve blocks are an integral part of multimodal analgesia and should be chosen based on their efficacy, convenience, and minimal side effects. Here, we compare the use of pectoral (PEC II) and serratus-intercostal fascial plane (SIFP) blocks in breast carcinoma cases undergoing modified radical mastectomy (MRM) in terms of the postoperative analgesic efficacy and shoulder mobility.Methods: The primary outcome of this prospective controlled study was to compare the postoperative static and dynamic pain scores, and the secondary outcome was to assess the shoulder pain, range of shoulder joint motion, and hemodynamic parameters. Sixty patients were randomly allocated to three groups and given general anesthesia. All patients received paracetamol, diclofenac, and rescue doses of tramadol based on the Institute's Acute Pain Service (APS) policy. No block was performed in group C (control), whereas groups P and S received PEC II and SIFP blocks, respectively, befo...
British Journal of Anaesthesia, 2016
Background: Pectoral nerve (PecS) block is a recently introduced technique for providing surgical anaesthesia and postoperative analgesia during breast surgery. The present study was planned to compare the efficacy and safety of ultrasound-guided PecS II block with thoracic paravertebral block (TPVB) for postoperative analgesia after modified radical mastectomy. Methods: Forty adult female patients undergoing radical mastectomy were randomly allocated into two groups. Group 1 patients received a TPVB with ropivacaine 0.5%, 25 ml, whereas Group 2 patents received a PecS II block using same volume of ropivacaine 0.5% before induction of anaesthesia. Patient-controlled morphine analgesia was used for postoperative pain relief. Results: The duration of analgesia was significantly prolonged in patients receiving the PecS II block compared with TPVB [mean (), 294.5 (52.76) vs 197.5 (31.35) min in the PecS II and TPVB group, respectively; P<0.0001]. The 24 h morphine consumption was also less in the PecS II block group [mean (), 3.90 (0.79) vs 5.30 (0.98) mg in PecS II and TPVB group, respectively; P<0.0001]. Postoperative pain scores were lower in the PecS II group compared with the TVPB group in the initial 2 h after surgery [median (IQR), 2 (2-2.5) vs 4 (3-4) in the Pecs II and TPVB group, respectively; P<0.0001]. Seventeen patients in the PecS II block group had T2 dermatomal spread compared with four patients in the TPVB group (P<0.001). No block-related complication was recorded. Conclusions: We found that the PecS II block provided superior postoperative analgesia than the TPVB in patients undergoing modified radical mastectomy without causing any adverse effect. Clinical trial registration: CTRI/2014/06/004692.
Bangladesh Journal of Pain, 2022
Background: Incomplete alleviation of postoperative pain in modified radical mastectomy surgery causes significant morbidity and patient dissatisfaction. General anaesthesia with postoperative NSAIDs and opioids commonly used technique for postoperative analgesia after breast surgeries. Along with regional anaesthesia various peripheral nerve blocks are performed to manage this problem. Paravertebral block and pectoral nerve block are exercised widely to reduce postoperative pain after modified radical mastectomy. Objective: The aim of this study is to assess the effectiveness of ultrasonography guided paravertebral block and pectoral nerve block for postoperative analgesia for modified radical mastectomy. Methods: This randomized control trial was conducted at Dhaka Medical College & Hospital, Dhaka from July 2020 to June 2021. Total 60 patients, scheduled for modified radical mastectomy and randomly divided into two groups having 30 patients in each (Group-A= paravertebral block and Group-B =pectoral nerve block). Among them, 5 patients were excluded from the study due to block failure (three in group A and two in group B). So, finally, data were calculated for the 55 patients (27 patients in group A and 28 in group B). Heart rate, systolic blood pressure, mean arterial pressure, the time of first analgesic demand and the total amount of analgesic consumption in the first 24 hours by VAS were recorded and compared between two groups during postoperative period. Statistical analysis was done by SPSS version 25. Chi-square test was done for qualitative variables and Student’s t-test was done for quantitative variables. P < 0.05 was considered statistically significant. Results: The demographic profile were well matched between two groups (P > 0.05). The mean VAS score was significantly lower in pectoral nerve block as compared to the paravertebral block at all-time intervals except at 12 hours and 20 hours (P < 0.05). Patients with pectoral nerve block had significantly late 1st analgesic demand (12.2 ± 2.1 hours’ vs 8.3 ± 1.8 hours) (P < 0.05) and significantly less total opioid consumption (165.7 ± 18.2mg vs 255.6 ± 15.8mg) (P < 0.05) compared to patients with paravertebral block. Post-operative side effects were noted significantly more in patients with paravertebral block compared to pectoral nerve block. Conclusion: Pectoral nerve block performed in patients scheduled for modified radical mastectomy results in better pain control, late first analgesic demand and less postoperative opioid consumption in the first 24 hours than paravertebral block.
Asian Journal of Pharmaceutical and Clinical Research
Objective: We administered intraoperative pectoral nerve block after tissue resection was over and assessed its analgesic efficacy with conventional post-operative intravenous opioids in patients undergoing modified radical mastectomy. Methods: Sixty patients undergoing modified radical mastectomy surgery were enrolled in this prospective, randomized, and doubleblinded study. After general anesthesia and surgical resection in both groups, Group P received pectoralis (PECS) block under vision with ropivacaine at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoral major and minor at the level of the third rib and Group T received tramadol (75 mg) in thrice daily frequency and 2% lignocaine infiltration at suture site. Primary objectives were to assess visual analog scale (VAS) scores over 24 h, time to first request for rescue analgesia (ketorolac) and total dose of analgesics needed, and secondary outcome was adverse effects and patient sat...
Acta Oncologica Turcica
Bu çalışmamızda onkolojik nedenli mastektomi sonrası ağrı tedavisi için uygulanmış infiltrasyon analjezisi ve pektoral sinir bloğu yöntemlerini, ağrı skorları, total analjezik tüketimi ve post anestezi bakım ünitesinden taburculuk süresine etkisi yönünden birbirlerine üstünlüklerini karşılaştırmayı amaçladık. YÖNTEM ve GEREÇLER: Etik kurul izni ve hasta onamları alındıktan, meme kanseri nedeniyle mastektomi uygulanmış, 18-80 yaş arası 60 hasta çalışmaya alındı. Postoperatif analjezi amacıyla pektoral sinir bloğu uygulanmış hastalar Grup I, infiltrasyon analjezisi uygulanmış hastalar ise Grup II olarak iki gruba ayrıldı. Bütün hastalara intraoperatif tenoxicam 20 mg uygulandı. Hastaların operasyon sonrası ağrıları Visual Analog Scala (VAS) ile 1, 6, 12 ve 24. saatlerde değerlendirildi. VAS değeri 3 üzeri olan hastalara tramadol 1mg/kg ve gerekirse morfin (0.5-1 mg) uygulandı. Postoperatif ilk 24 saatte tükettikleri toplam analjezik miktarları, post anestezik bakım ünitesinde kalış süreleri, bulantı-kusma ve diğer yan etki oranları kaydedildi, sonuçlar istatistiksel olarak değerlendirildi. BULGULAR: Demografik özellikler iki grupta benzerdi. Postoperatif VAS ortalamaları pektoral sinir bloğu grubunda 1, 6, 12 ve 24. saatlerde infiltrasyon analjezisi grubuna göre anlamlı olarak düşük bulundu. Hastaların yirmi dört saatte tükettikleri total analjezik miktarı, bulantı-kusma, diğer yan etki oranları ve post anestezi bakım ünitesinde kalış süresi pektoral sinir bloğu grubunda anlamlı olarak düşüktü. TARTIŞMA ve SONUÇ: Çalışmamızda onkolojik meme cerrahisi sonrası ağrı yönetiminde, pektoral sinir bloğu yöntemi infiltrasyon analjezisi yöntemine göre üstün bulundu. Sonuç olarak, meme kanseri nedenli mastektomi sonrası, pektoral sinir bloğunu etkili bir ağrı yönetimi ve post anestezik bakım ünitesinden erken taburculuk sağladığı için tavsiye ediyoruz. Anahtar Kelimeler: Onkolojik meme cerrahisi, postoperatif ağrı tedavisi, infiltrasyon analjezisi, pektoral sinir bloğu, opiyoid tüketimi ABSTRACT INTRODUCTION: In this study, we aimed to compare the superiority of infiltration analgesia and pectoral nerve block methods on pain scores, total opioid consumption and discharge time from post anesthesia care unit (PACU) of patients after oncologic mastectomy. METHODS: After approval of the ethics committee and patient consent, sixty patients who underwent mastectomy for breast cancer between 18-80 years of age were included in the study. Patients were divided into two groups, who underwent pectoral nerve block for postoperative analgesia as Group I and infiltration analgesia as Group II. Intraoperative tenoxicam of 20 mg was applied to all patients. Postoperative pain was evaluated with Visual Analog Scala (VAS) at the 1st, 6th, 12th and 24th hours. Patients with a VAS of more than 3 were given tramadol 1 mg/kg and morphine (05-1 mg) if necessary. In the first 24 hours postoperatively, total analgesic consumption, discharge time from PACU, rates of nausea, vomiting and other side effects of patients were recorded and results were evaluated statistically. RESULTS: Demographic characteristics were similar in two groups. Postoperative VAS scores were significantly lower in the pectoral nerve block group at the 1st, 6th, 12th and 24th hours compared to the infiltration analgesia group. The total analgesic consumption, nausea-vomiting rate, and discharge time from PACU were significantly lower in the pectoral nerve block group. DISCUSSION AND CONCLUSION: In our study, pectoral nerve block method was found superior to infiltration analgesia method on postoperative pain management in oncologic breast surgery. In conclusion, we recommend the pectoral nerve block to supply effective pain management and early discharge time from PACU after mastectomy for breast cancer.
IP innovative publication pvt. ltd, 2019
Introduction: Pectoral Nerve block is an interfascial plane block which provides analgesia after breast cancer surgery while Thoracic Paravertebral block is also widely used. This study is designed to compare the quality of analgesia after Modified Radical Mastectomy using the two techniques in terms of, the time for the first request of rescue analgesic, 24 hrs analgesic requirement, Visual Analogue Score for pain at rest at 1 and 6 hours postoperatively. Results: Patients undergoing breast cancer surgeries done under general anaesthesia at Govt. Kilpauk Medical College and Govt. Royapettah Hospital, Chennai between January 2017 and June 2017 belonging to ASA 1 & 2 were included in this study, 30 patients in PECS group and 30 in TPB group. In TPB group, the time for first rescue analgesia was between 141-360 minutes postoperatively (n=17, 56.67%) than in PECS group where the time for first rescue analgesia was between 121-240 minutes postoperatively (n=27, 90.00%)(p= <0.0001, unpaired t test) 24 hours analgesic consumption in TPB group was100 mg tramadol postoperatively (n=26, 86.67%) while in PECS group it was 300 mg tramadol postoperatively (n=13, 43.33%)(p= <0.0001, unpaired t test). VAS scores in TPB group at 1 hour and 6 hours postoperatively were 0.00 and 2.13 while VAS in PECS group at 1 hour and 6 hours were 2.00 and 4.00(p= <0.0001, unpaired t test) Conclusion: Thoracic paravertebral block reduced the 24 hour analgesic consumption, reduced VAS scores at 1 and 6 hours and prolonged the time required for the first request of analgesic compared to pectoral nerve block after modified radical mastectomy