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Erschienen in: Indian Journal of Surgical Oncology 1/2023

14.11.2022 | Original Article

Postoperative Analgesic Efficacy of Intraoperative Pectoral Nerve Block for Modified Radical Mastectomy: a Double-Blind Prospective Randomised Interventional Study

verfasst von: Rohit Jindal, Sushila Meena, Sushil Bhati, Pinakin Patel, Chanchal Gulati, Suresh Singh

Erschienen in: Indian Journal of Surgical Oncology | Ausgabe 1/2023

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Abstract

Severe acute postoperative pain following breast surgery increases the risk of persistent pain and affects the recovery of patients. Recently, pectoral nerve (PECs) block has gained significance as a regional fascial block that can provide adequate postoperative analgesia. This study aimed to evaluate the safety and efficacy of PECs II block, which was given intraoperative under direct vision after performing modified radical mastectomy for breast cancer patients. This prospective randomised study was comprised of a PECs II group (n = 30) and a control group (n = 30). Group A patients received 25 ml of 0.25% bupivacaine for PECs II block intraoperatively after the surgical resection was done. Both groups were compared with respect to the demographic and clinical parameters, total intraoperative fentanyl dose, total duration of surgery, postoperative pain score (Numerical Rating Scale) and the analgesic requirement, postoperative complications, postoperative duration of hospital stay, and the outcome. Intraoperative PECs II block was not associated with any increase in the duration of surgery. The postoperative pain scores were significantly higher in the control group till 24 h after the surgery, and so was the postoperative analgesic requirement. Patients in the PECs group were found to have rapid recovery and decreased postoperative complications. Intraoperative PECs II block is not only safe, time-saving procedure but also significantly reduces the postoperative pain and analgesic requirement in breast cancer surgeries. It is also associated with a faster recovery, decreased postoperative complications, and better patient satisfaction.
Literatur
3.
Zurück zum Zitat Gonzales J, Lovald ST, Lau EC, Ong KL (2018) Risk of opioid-related adverse events after primary and revision total knee arthroplasty. J Surg Orthop Adv 27(2):148–54PubMed Gonzales J, Lovald ST, Lau EC, Ong KL (2018) Risk of opioid-related adverse events after primary and revision total knee arthroplasty. J Surg Orthop Adv 27(2):148–54PubMed
6.
Zurück zum Zitat Blanco R, Fajardo M, Maldonado TP (2012) Ultrasound description of Pecs II (modifiedPecsI): a novel approach to breast surgery. Rev Esp Anestesiol Reanim 59(9):470–475CrossRefPubMed Blanco R, Fajardo M, Maldonado TP (2012) Ultrasound description of Pecs II (modifiedPecsI): a novel approach to breast surgery. Rev Esp Anestesiol Reanim 59(9):470–475CrossRefPubMed
7.
Zurück zum Zitat Westbrook AJ, Buggy DJ (2003) Anaesthesia for breast surgery. Br J Anaesth 8(5):151–154 Westbrook AJ, Buggy DJ (2003) Anaesthesia for breast surgery. Br J Anaesth 8(5):151–154
8.
Zurück zum Zitat Gonzales J (2016) PECS versus PVBS for perioperative analgesic management in breast surgery. ASRA News 16(3):41–44 Gonzales J (2016) PECS versus PVBS for perioperative analgesic management in breast surgery. ASRA News 16(3):41–44
9.
Zurück zum Zitat Jin Z, Li R, Gan TJ, He Y, Lin J (2020) Pectoral Nerve (PECs) block for postoperative analgesia-a systematic review and meta-analysis with trial sequential analysis. Int J Physiol Pathophysiol Pharmacol 12(1):40–50PubMedPubMedCentral Jin Z, Li R, Gan TJ, He Y, Lin J (2020) Pectoral Nerve (PECs) block for postoperative analgesia-a systematic review and meta-analysis with trial sequential analysis. Int J Physiol Pathophysiol Pharmacol 12(1):40–50PubMedPubMedCentral
10.
Zurück zum Zitat Kulhari S, Bharti N, Bala I, Arora S, Singh G (2016) Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth 117:382–386CrossRefPubMed Kulhari S, Bharti N, Bala I, Arora S, Singh G (2016) Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth 117:382–386CrossRefPubMed
11.
Zurück zum Zitat Bashandy GMN, Abbas DN (2015) Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med 40(1):68–74CrossRefPubMed Bashandy GMN, Abbas DN (2015) Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med 40(1):68–74CrossRefPubMed
12.
Zurück zum Zitat Eldeen HMS (2016) Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: a randomized controlled trial. Egypt J Anaesthesia 32(1):29–35CrossRef Eldeen HMS (2016) Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: a randomized controlled trial. Egypt J Anaesthesia 32(1):29–35CrossRef
13.
15.
Zurück zum Zitat Jensen MP, McFarland CA (1993) Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 55:195–203CrossRefPubMed Jensen MP, McFarland CA (1993) Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 55:195–203CrossRefPubMed
16.
Zurück zum Zitat Syal K, Chandel A (2017) Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy: a randomised double-blind trial. Indian J Anaest 61:643–685CrossRef Syal K, Chandel A (2017) Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy: a randomised double-blind trial. Indian J Anaest 61:643–685CrossRef
18.
Zurück zum Zitat Kim D, Kim S, Kim CS et al (2018) Efficacy of pectoral nerve block type II for breast-conserving surgery and sentinel lymph node biopsy: a prospective randomized controlled study. Pain Res Manag 2018:1–8 Kim D, Kim S, Kim CS et al (2018) Efficacy of pectoral nerve block type II for breast-conserving surgery and sentinel lymph node biopsy: a prospective randomized controlled study. Pain Res Manag 2018:1–8
19.
Zurück zum Zitat Blanco R, Barrington MJ (2017) Pectoralis and serratus plane blocks. In: Hadzic A (ed) Hadzic’s Textbook of regional anesthesia and acute pain management, 2nd edn. McGraw-Hill Education, New York, pp 650–660 Blanco R, Barrington MJ (2017) Pectoralis and serratus plane blocks. In: Hadzic A (ed) Hadzic’s Textbook of regional anesthesia and acute pain management, 2nd edn. McGraw-Hill Education, New York, pp 650–660
21.
Zurück zum Zitat Bashandy GM, Abbas DN (2015) Pectoral nerves I and II blocks in multimodal analgesia in breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med 40(1):68–74CrossRefPubMed Bashandy GM, Abbas DN (2015) Pectoral nerves I and II blocks in multimodal analgesia in breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med 40(1):68–74CrossRefPubMed
Metadaten
Titel
Postoperative Analgesic Efficacy of Intraoperative Pectoral Nerve Block for Modified Radical Mastectomy: a Double-Blind Prospective Randomised Interventional Study
verfasst von
Rohit Jindal
Sushila Meena
Sushil Bhati
Pinakin Patel
Chanchal Gulati
Suresh Singh
Publikationsdatum
14.11.2022
Verlag
Springer India
Erschienen in
Indian Journal of Surgical Oncology / Ausgabe 1/2023
Print ISSN: 0975-7651
Elektronische ISSN: 0976-6952
DOI
https://doi.org/10.1007/s13193-022-01680-x

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