Efficacy of Peripheral Nerve Stimulator Guided Pectoral Nerve Block-1 and Serratus Anterior Plane Block for Post-operative Analgesia in Modified Radical Mastectomy: A Randomized Controlled Study (original) (raw)
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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...
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.
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.
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.
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
BJA: British Journal of Anaesthesia, 2017
Background. Pectoral nerve block1 (PEC1) given between pectoralis major and minor, and modified pectoral nerve block2 (mPEC2) performed between pectoralis minor and serratus anterior, can provide continuous analgesia after modified radical mastectomy (MRM) when catheters are placed before skin closure. This study was designed to compare PEC1 and mPEC2 block for providing postoperative pain relief after MRM. Methods. Sixty-two physically fit patients undergoing MRM were assigned into two groups (Group PEC1, n¼31 and Group mPEC2, n¼31). Before wound closure, epidural catheter was placed in the group designated muscle plane and 30ml of 0.25% bupivacaine was injected through the catheter after wound closure. Bupivacaine 15ml of 0.25% top up was given on patient's demand or whenever visual analogue scale (VAS) score was>4. Time for first analgesia (TFA), number of top ups and VAS was recorded at 0.5, 6, 12, 18, 24 h after surgery. Sensory blockade was assessed 30 min after extubation. Results. Analgesia was significantly prolonged in group mPEC2 [mean(SD)] 313.45(43.05) vs 258.87(34.71) min in group PEC1, P<0.001. Total pain experienced over 24 h was significantly less in group mPEC2 [mean(SD)] 9.77(6.93) than in group PEC1 24.19(10.81), P<0.0001. Consequently, top up requirements were significantly reduced in group mPEC2 than in group PEC1 [median(range)] 3(2-4) vs 4(3-5) respectively, P<0.001. Lateral pectoral (77.42% and 35.48%) and thoracodorsal nerves (93.55% and 48.39%) had higher incidence of sensory block in group mPEC2 than group PEC1, P<0.001. Conclusions. mPEC2 provides better postoperative analgesia than PEC1 when catheters are placed under direct vision after MRM. Clinical trial registration.
IP Innovative Publication Pvt. Ltd., 2018
This study compares the safety and efficacy of multiple level thoracic paravertebral block and modified Pecs block for postoperative pain relief after Modified Radical Mastectomies. After Institutional Review Board [IRB] and Human Ethics Committee [HEC approval, the study was conducted on 41 patients who were scheduled to undergo modified radical mastectomy. Written informed consent was taken. Female patients in the age group of 18-75 years who were ASA grade I and II were randomly allocated to two groups to either receive Ultrasound guided Thoracic paravertebral block TPVB at T2 and T4 levels (Group 2) or an ultrasound guided modified PECS block (Group 1) preoperatively in the block room. Paravertebral block was given at two vertebral levels T2 (10 ml) and T4 level (10 ml) under ultrasound guidance utilising the parasagital in-plane technique. Modified PEC block was administered to patients in the PEC group.10 ml of 0.5% Ropivacaine for Pec1 and 20ml for Pec 2. In all patients surgery was done under GA. Pain was assessed with Numerical Rating Scale (NRS) on a 0 to 10 scale, for 24 hours after surgery, at 0,0.5,1,1.5,2,4,6,12 and 24 hours after surgery by a blinded observer. Rescue opioid and Paracetamol requirement was recorded. The patients were also monitored for any specific block related complications. Primary outcome measures were the numerical rating scores for pain and rescue analgesic requirement. Secondary outcome measures was looking for any block related complications. Demographic categorical variables were expressed in frequency and percentage, and the continuous variables were reported in terms of mean and standard deviation. The comparison of pain scores between the thoracic paravertebral nerve block and modified pectoral nerve block was done using Mann-Whitney U test. Mean duration of analgesia and mean 24 hour Morphine, Paracetamol consumption was compared using Student's t test. There was no statistically significant difference between the two groups with respect to the pain scores at 0,0.5,1,1.5,2,4,6,12,and 24 hours at rest or with movement of the ipsilateral arm. The 24 hour Morphine consumption was not also statistically significant. [pec gp,mean 2.17, SD 1.09, tpvb gp mean 2 SD 0.77, p value 0.752.] Paracetamol consumption in the initial 24 hours after surgery was also not statistically significant between the two groups (pec gp. 36.8% and tpvb gp. 50% patients received paracetamol with a p value of 0.523). We found both the blocks, modified Pecs and multiple level paravertebral block were equally effective in treating postoperative pain. Keywords: Modified pectoral nerve block, Multiple level thoracic paravertebral block, Postoperative analgesia, Modified radical mastectomy.
A randomised controlled trial of the pectoral nerves-2 (PECS-2) block for radical mastectomy
Anesthesia, 2018
We randomly allocated 50 women scheduled for radical mastectomy to pectoral nerves-2 (PECS-2) block (n = 25) or no block (n = 25), 20 and 22 of whom we analysed for the primary outcome of a cumulative 24-h postoperative morphine dose. We gave intra-operative sufentanil, magnesium, dexamethasone and droperidol. Participants received regular postoperative paracetamol, ibuprofen and patient-controlled intravenous morphine. Pectoral nerves-2 block reduced mean (SD) cumulative 24 h postoperative morphine dose from 9.7 (8.9) mg to 5.0 (5.4) mg and 48 h morphine dose from 12.8 (12.5) mg to 6.0 (6.5) mg, p = 0.04 for both. The mean (SD) pain scores 24 h and 48 h after surgery were similar with or without block: 0.8 (1.4) vs. 1.2 (1.9), p = 0.39; and 0.2 (0.4) vs. 0.9 (1.8), p = 0.09, respectively. Rates of postoperative nausea, vomiting and pruritus were unaffected. Rates of chronic pain at six postoperative months were 2/19 and 2/18 after block and no block, respectively, p = 0.95.
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...