Comparison of ultrasonography-guided pectoral nerve block with patient-controlled analgesia for breast surgery patients

Year 2021, Volume: 7 Issue: 2, 136 - 141, 04.03.2021

Gokhan İsık Serce Evrim Kucur Tulubas

https://doi.org/10.18621/eurj.584619

Abstract

Objectives: Pectoral nerve block is an effective method that can be applied for analgesic purposes in breast surgery. In this prospective study we aimed to compare the postoperative analgesic efficacy of pectoral nerve block for postoperative analgesia and patient-controlled analgesia (PCA) for patients undergoing breast surgery in terms of the incidence of nausea and vomiting.

Methods: The study included 93 patients who underwent ASA I-II anesthesia and breast surgery. Group 1 was PCA group, group 2 was PECS (Pectoral Nerves) block group. PECS block was administered as PECS-1 and PECS-2 block under the guidance of ultrasonography. Patients investigated in the study had postoperative monitoring forms examined for vital signs and visual analog scale (VAS) scores in the 1st, 6th and 24th hours.

Results: When the pectoral nerve block with bupivacaine under ultrasound guidance was compared with PCA device, there were significant reductions in VAS score at 24 hours.(1.53 vs 4.27, 1.10 vs 3.27 and 0.90 vs 1.93, respectively; p = 0.0001). Although there was no significant difference in terms of vomiting, there was a difference in favor of pectoral nerve block especially at the postoperative 6th hour in terms of nausea.

Conclusions: Pectoral nerve block can be used in the patients undergoing breast surgery due to the lower visual analog score and nausea incidence in the postoperative period.

Keywords

Breast surgery, pectoral nerve block, ultrasonography, patient-controlled analgesia

References

• 1. Desroches J, Grabs U, Grabs D. Selective ultrasound guided pectoral nerve targeting in breast augmentation: How to spare the brachial plexus cords? Clin Anat 2013;26:49-55.
• 2. Fecho K, Miller NR, Merrit SA, Klauber-Demore N, Hultman CS, Blau WS. Acute and persistent postoperative pain after breast surgery. Pain Med 2009;10:708-15.
• 3. Perlas A, Niazi A, McCartney C, Chan V, Xu D, Abbas S. The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound. Reg Anesth Pain Med 2006;31:445-50.
• 4. Ono K, Danura T, Koyama Y, Hidaka H. [Combined use of paravertebral block and general anesthesia for breast cancer surgery]. Masui 2005;54:1273-6. [Article in Japanese]
• 5. Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere P. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesth Analg 2004;99:1837-43.
• 6. Moskowitz AS, Goodman RR. Autoradiographic analysis of mu1, mu2, and delta opioid binding in the central nervous system of C57BL/6BY and CXBK (opioid receptor-deficient) mice. Brain Res 1985;360:108-16.
• 7. Arunakul P, Ruksa A. General anesthesia with thoracic paravertebral block for modified radical mastectomy. J Med Assoc Thai 2010;93.Suppl 7:: S149-53.
• 8. Boughey JC, Goravanchi F, Parris RN, Kee SS, Kowalski AM, Frenzel JC, et al. Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery. Am J Surg 2009;198:720-5.
• 9. Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carlsson PS. Thoracic paravertebral block for breast cancer surgery: a randomized double-blind study. Anesth Analg 2007;105:1848-51.
• 10. Schnabel A, Reichl SU, Kranke P, Pogatzki EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 2010;105:842-52.
• 11. Dinges HC, Otto S, Stay DK, Bäumlein S, Waldmann S, Kranke P, et al. Effect rates of opioids in equianalgesic doses via intravenous patient-controlled analgesia: a systematic review and network meta-analysis. Anesth Analg 2019;129:1153-62.
• 12. Nathanson SD, Wachna DL, Gilman D, Karvelis K, Havstad S, Ferrara J. Pathways of lymphatic drainage from the breast. Ann Surg Oncol 2001;8:837-43.
• 13. Kenny GNC. Ketorolac trometamol--a new non-opioid analgesic. Br J Anaesth 1990;65:445-7.
• 14. Bashandy GMN, Dina NA. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med 2015;40:68-74.
• 15. Neethu M, Pandey RK, Sharma A, Darlong V, Punj J, Sinha, et al. Pectoral nerve blocks to improve analgesia after breast cancer surgery: a prospective, randomized and controlled trial. J Clin Anesthesia 2018;45:12-7.
• 16. Morioka H, Kamiya Y, Yoshida T, Baba H. Pectoral nerve block combined with general anesthesia for breast cancer surgery: a retrospective comparison. JA Clin Rep 2015;1:5.
• 17. Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth 2016;117:382-6.
• 18. Cros J, Senges P, Kaprelian S, Desroches J, Gagnon C, Labrunie A, et al. Pectoral I block does not improve postoperative analgesia after breast cancer surgery: a randomized, double-blind, dual-centered controlled trial. Reg Anesh Pain Med 2018;43:596-604.
• 19. Guzzetti L, Danelli G, Ricci B, Torrano V, Russo G, Fusco P, et al. An observational analysis about novel chest wall blocks (PECS and SERRATUS) during breast surgery. Austin J Surg 2016;3:1-5.
• 20. Eldeen HMS. Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: a randomized controlled trial. Egypt J Anaesth 2016;32:29-35.