Background
Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection.
Methods
This randomized, double-blind, placebo-controlled trial performed in Renmin Hospital, Wuhan University, enrolled 41 participants aged 18–65 years. The patients scheduled for mediastinal mass resection by median sternotomy were randomly assigned were randomized into 2 groups, and preoperatively administered 2 injections of ropivacaine (PSI) and saline (control) groups, respectively, in the 3rd and 5th parasternal intercostal spaces with ultrasound-guided (USG) bilateral parasternal intercostal nerve block. Sufentanil via patient-controlled intravenous analgesia (PCIA) was administered to all participants postoperatively. Pain score, total sufentanil consumption, and postoperative adverse events were recorded within the first 24 h.
Results
There were 20 and 21 patients in the PSI and control group, respectively. The PSI group required 20% less PCIA-sufentanil compared with the control group (54.05 ± 11.14 μg vs. 67.67 ± 8.92 μg, P < 0.001). In addition, pain numerical rating scale (NRS) scores were significantly lower in the PSI group compared with control patients, both at rest and upon coughing within 24 postoperative hours. Postoperative adverse events were generally reduced in the PSI group compared with controls.
Conclusions
USG bilateral parasternal intercostal nerve block effectively reduces postoperative pain and adjuvant analgesic requirement, with good patient satisfaction, therefore constituting a good option for mediastinal mass resection by median sternotomy.
Background: Simultaneous application of pectoral nerve block and serratus-intercostal plane
block (SPB) is one of the most desirable multimodal analgesic strategies, with wide implementation
of the enhanced recovery after surgery pathway for modified radical mastectomy (MRM).
Objectives: The aim of the present study was to investigate the efficacy and safety of ultrasoundguided pectoral nerve block I (PECS I) and SPB for postoperative analgesia following MRM.
Study Design: A randomized, prospective study.
Setting: An academic medical center.
Methods: A total of 61 women undergoing MRM were randomly divided into 2 groups. The
control group (group C, n = 32) received general anesthesia only, whereas the PECS I + SPB treated
group (group PS, n = 29) received a combination of pectoral nerve block and SPB in addition to
general anesthesia.
Results: Pain scores on a visual analog scale, opioid consumption, the duration at the
postanesthesia care unit, and the incidence of adverse events were lower in group PS, compared
with that of the group C. Moreover, PECS I together with SPB contributed to better sleep quality
and higher patient satisfaction of pain relief.
Limitations: This study was limited by its sample size.
Conclusions: These results suggest that the combination of PECS I and SPB provide superior
perioperative pain relief in breast cancer surgery.
Key words: Pectoral nerve block, serratus-intercostal plane block, postoperative analgesia,
modified radical mastectomy
Purpose: Pectoral nerve block I (PECS I) and serratus-intercostal plane block (SIPB) can anesthetize the majority mammary region, while parasternal intercostal block (PSI) targets the internal area during breast resection surgery. The aim of this study was to determine whether including PSI with PECS I and SIPB is more effective compared to PECS I and SIPB alone. Patients and Methods: Sixty-two adult females undergoing unilateral modified radical mastectomy (MRM) were randomly assigned to receive either PECS I and SIPB (PS group, n=31) or a combination of PECS I, SIPB, and PSI (PSP group, n=31). The outcomes were measured with a numerical rating scale (NRS) score, and in terms of opioid consumption and anesthesia-related complications within 48 h after surgery. Results: Although there were no differences in the NRS scores between the two groups during the inactive periods, the combination of three nerve blocks significantly reduced the NRS scores during movement. In addition, morphine equivalent consumption was lower in the PSP group compared to the PS group. Postoperative adverse events were similar in both groups in terms of regional anesthesia-related complications. Conclusion: The combination of PECS I block, SIPB, and PSI block provides superior pain relief and postoperative recovery for patients undergoing MRM.
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