A randomised controlled study of the post-operative analgesic efficacy of ultrasound-guided pectoral nerve block in the first 24 h after modified radical mastectomy

Kumar, Satish; Goel, Divya; Sharma, Santosh Kumar; Ahmad, Sajjad; Dwivedi, Priyanka; Deo, Narendra; Rani, Raka

doi:10.4103/ija.ija_523_17

Cited by 40 publications

(21 citation statements)

References 17 publications

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“…After review, a further 1116 studies were excluded as not meeting our predefined criteria. Finally, 62 studies evaluating nine different regional analgesia techniques were used for the quantitative analysis 14–75 . The regional and local analgesia techniques were: erector spinae plane (ESP) block, local anaesthetic infiltration, paravertebral block (PVB), pectoserratus plane (PS) block, superficial serratus anterior plane (sSAP) block, retrolaminar block, deep serratus anterior plane (dSAP) block, rhomboid plane block, interpectoral-pectoserratus (IP-PS) block.…”

Section: Resultsmentioning

confidence: 99%

Single-injection regional analgesia techniques for mastectomy surgery

Cassai

Zarantonello

Geraldini

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Patients undergoing mastectomy surgery experience severe postoperative pain. Several regional techniques have been developed to reduce pain intensity but it is unclear, which of these techniques is most effective.OBJECTIVES To synthesise direct and indirect comparisons for the relative efficacy of different regional and local analgesia techniques in the setting of unilateral mastectomy. Postoperative opioid consumption at 24 h, postoperative pain at extubation, 1, 12 and 24 h, postoperative nausea and vomiting were collected.DESIGN Systematic review with network meta-analysis (PROSPERO: CRD42021250651).DATA SOURCE PubMed, Scopus, the Cochrane Central Register of Controlled Trials (from inception until 7 July 2021).ELIGIBILITY CRITERIA All randomised controlled trials investigating single-injection regional and local analgesia techniques in adult patients undergoing unilateral mastectomy were included in our study without any language or publication date restriction.RESULTS Sixty-two included studies randomising 4074 patients and investigating nine techniques entered the analysis. All techniques were associated with less opioid consumption compared with controls The greatest mean difference [95% confidence interval (CI)] was associated with deep serratus anterior plane block: mean difference -16.1 mg (95% CI, -20.7 to -11.6). The greatest reduction in pain score was associated with the interpectoral-pectoserratus plane block (mean difference -1.3, 95% CI, -1.6 to -1) at 12 h postoperatively, and with superficial serratus anterior plane block (mean difference -1.4, 95% CI, -2.4 to -0.5) at 24 h. Interpectoral-pectoserratus plane block resulted in the greatest statistically significant reduction in postoperative nausea/vomiting when compared with placebo/no intervention with an OR of 0.23 (95% CI, 0.13 to 0.40).CONCLUSION All techniques were associated with superior analgesia and less opioid consumption compared with controls. No single technique was identified as superior to others. In comparison, local anaesthetic infiltration does not offer advantages over multimodal analgesia alone.TRIAL REGISTRATION PROSPERO (CRD4202125065).

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Section: Resultsmentioning

confidence: 99%

Single-injection regional analgesia techniques for mastectomy surgery

Cassai

Zarantonello

Geraldini

et al. 2021

European Journal of Anaesthesiology

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“…Twenty-two of them were excluded. Finally, 37 studies were included in the quantitative synthesis,9,10,17–19,24–55 and 47 studies were included in the qualitative synthesis9,10,17–19,24–65 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…The pooled results of 3 studies with 180 participants significantly favored Pecs II block with dexmedetomidine than Pecs II block alone (MD = 249.46, 95% CI [126. 38,372.54], P < 0.0001) and Pooled results were heterogeneous (P < 0.003, I 2 = 83%) (Fig. 6).…”

Section: Effect Of Addition Of Dexmedetomidine To Pecs IImentioning

confidence: 94%

Efficacy and Safety of Pectoral Nerve Block (Pecs) Compared With Control, Paravertebral Block, Erector Spinae Plane Block, and Local Anesthesia in Patients Undergoing Breast Cancer Surgeries

Elshanbary¹,

Zaazouee

Darwish

et al. 2021

The Clinical Journal of Pain

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Objective: We aimed to compare the safety and efficacy of pectoral nerve block (Pecs) I and II with control or other techniques used during breast cancer surgeries such as local anesthesia, paravertebral block, and erector spinae plane block (ESPB). Methods:We searched 4 search engines (PubMed, Cochrane Library, Scopus, and Web of Science) for relevant trials, then extracted the data and combined them under random-effect model using Review Manager Software. Results:We found 47 studies, 37 of them were included in our metaanalysis. Regarding intraoperative opioid consumption, compared with control, a significant reduction was detected in Pecs II (standardized mean difference [SMD] = −1.75, 95% confidence interval [CI] [−2.66, −0.85], P = 0.0001) and Pecs I combined with serratus plane block (SMD = −0.90, 95% CI [−1.37, −0.44], P = 0.0002). Postoperative opioid consumption was significantly lowered in Pecs II (SMD = −2.28, 95% CI [−3.10, −1.46], P < 0.00001) compared with control and Pecs II compared with ESPB (SMD = −1.75, 95% CI [−2.53, −0.98], P < 0.00001). Furthermore, addition of dexmedetomidine to Pecs II significantly reduced postoperative opioid consumption compared with Pecs II alone (SMD = −1.33, 95% CI [−2.28, −0.38], P = 0.006). Conclusion:Pecs block is a safe and effective analgesic procedure during breast cancer surgeries. It shows lower intra and postoperative opioid consumption than ESPB, and reduces pain compared with control, paravertebral block, and local anesthesia, with better effect when combined with dexmedetomidine.

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“…In previous studies, all patients received neuromuscular blocking agents, were endotracheally intubated and administered anaesthesia based on volatile anaesthetics, the control groups did not receive specific long-acting analgesia late during surgery and thus had minimal analgesia on entering the PACU. [7][8][9][10][11][12] In some studies, unacceptable pain was reported in the control groups. 7,11 According to the prospect working group guidelines' consensus document, the preferred anaesthesia for breast cancer surgery is premedication with paracetamol as well as a NSAID, and a steroid.…”

Section: Discussionmentioning

confidence: 99%

Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery

Ahlberg

Wallgren

Hultin

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDSurgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).OBJECTIVEWe aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.DESIGNA randomised controlled study.SETTINGOperating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.PATIENTSAmong the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.INTERVENTIONAll patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.MAIN OUTCOME MEASUREThe primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.RESULTSData from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P = 0.357).CONCLUSIONThe use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT03117894.

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A randomised controlled study of the post-operative analgesic efficacy of ultrasound-guided pectoral nerve block in the first 24 h after modified radical mastectomy

Cited by 40 publications

References 17 publications

Single-injection regional analgesia techniques for mastectomy surgery

Single-injection regional analgesia techniques for mastectomy surgery

Efficacy and Safety of Pectoral Nerve Block (Pecs) Compared With Control, Paravertebral Block, Erector Spinae Plane Block, and Local Anesthesia in Patients Undergoing Breast Cancer Surgeries

Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery

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