A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy

Jabari, Aboud Al; Robertson, Moira; El‐Boghdadly, Kariem; Albrecht, Éric

doi:10.1111/anae.14769

Cited by 32 publications

(33 citation statements)

References 29 publications

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“…Intra‐operative opioid requirements were found to be significantly lower after a PECS‐2 block compared with no block . Lower pain scores and a reduction in postoperative opioid consumption have been reported in patients having PECS‐2 blocks compared with no block or placebo .…”

Section: Resultsmentioning

confidence: 89%

“…The pectoral nerves (PECS)‐1 block is performed by injecting local anaesthesia between the pectoralis major and minor muscles, whereas the PECS‐2 block includes the PECS‐1 interpectoral injection along with infiltration of local anaesthesia between the pectoralis minor and the serratus anterior muscles. Twelve studies have investigated the analgesic effects of intra‐operative PECS blocks in minor and major breast surgery . Intra‐operative opioid requirements were found to be significantly lower after a PECS‐2 block compared with no block .…”

Section: Resultsmentioning

confidence: 99%

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PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Summary Analgesic protocols used to treat pain after breast surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological breast surgery. A systematic review using preferred reporting items for systematic reviews and meta‐analysis guidance with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty‐nine studies were found, of which 53 randomised controlled trials and nine meta‐analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra‐operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non‐steroidal anti‐inflammatory drugs) administered pre‐operatively or intra‐operatively and continued postoperatively. In addition, pre‐operative gabapentin and dexamethasone are also recommended. In major breast surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…Postoperative care included administration of intravenous acetaminophen 1 g and ketorolac 30 mg (for multimodal anesthesia) and intravenous ondansetron 4 mg (for antiemetic prophylaxis), as per routine clinical practice at the study institution. 16 , 17 …”

Section: Methodsmentioning

confidence: 99%

The Relationship Between Postoperative Opioid Analgesia and Sleep Apnea Severity in Patients Undergoing Hip Arthroplasty: A Randomized, Controlled, Triple-Blinded Trial

Albrecht

Pereira

Bayon

et al. 2022

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Purpose Residual postoperative pain after hip arthroplasty is usually treated with oral opioids. While classic opioids are associated with respiratory depression and worsening of sleep apnea, tramadol has been reported to preserve respiratory function. However, this has not been investigated in a prospective trial using respiratory polygraphy. This randomized controlled triple-blinded trial tested the hypothesis that postoperative treatment with oral opioids such as oxycodone would increase sleep apnea severity, measured with a respiratory polygraphy, compared with oral tramadol. Patients and Methods Sixty patients undergoing hip arthroplasty under spinal anesthesia with 15 mg isobaric bupivacaine 0.5% were randomized to receive postoperative pain treatment with either oral oxycodone (controlled-release 10 mg every 12 hours and immediate-release 5 mg every 4 hours as needed) or oral tramadol (controlled-release 100 mg every 8 hours and immediate-release 50 mg every 4 hours as needed). Respiratory polygraphy was performed on the first postoperative night. The primary outcome was the apnea-hypopnea index in the supine position. Secondary outcomes included the oxygen desaturation index, postoperative pain scores and intravenous morphine consumption. Results Mean supine apnea-hypopnea index on postoperative night 1 was 11.3 events.h −1 (95% confidence interval, 4.8–17.7) in the oxycodone group and 10.7 (4.6–16.8) events.h −1 in the tramadol group (p=0.89). There were no significant differences between the oxycodone and tramadol groups with respect to any secondary sleep-related or pain-related outcomes. Conclusion Oral oxycodone did not increase sleep apnea severity measured using respiratory polygraphy compared with oral tramadol on the first postoperative night after hip arthroplasty. Trial Registration Number Clinicaltrials.gov – NCT03454217 (date of registration: 05/03/2018).

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“…After prosthesis implantation, the surgical site was infiltrated with 50 ml of ropivacaine 0.2%. As per routine institutional practice, at the end of surgery all patients received intravenous acetaminophen 1000 mg and intravenous ketorolac 30 mg for multimodal analgesia and intravenous ondansetron 4 mg for anti‐emetic prophylaxis [20, 21]. In case of residual neuromuscular blockade (defined as a train‐of‐four ratio < 0.9), muscle relaxation was antagonised with neostigmine 50 μg.kg −1 and glycopyrrolate 5–10 μg.kg −1 [22].…”

Section: Methodsmentioning

confidence: 99%

Impact of short‐acting vs. standard anaesthetic agents on obstructive sleep apnoea: a randomised, controlled, triple‐blind trial

et al. 2020

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Sleep apnoea is associated with negative outcomes following general anaesthesia. Current recommendations suggest using short-acting anaesthetic agents in preference to standard agents to reduce this risk, but there is currently no evidence to support this. This randomised controlled triple-blind trial tested the hypothesis that a combination of short-acting agents (desflurane-remifentanil) would reduce the postoperative impact of general anaesthesia on sleep apnoea severity compared with standard agents (sevoflurane-fentanyl). Sixty patients undergoing hip arthroplasty under general anaesthesia were randomised to anaesthesia with desfluraneremifentanil or sevoflurane-fentanyl. Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the supine apnoea-hypopnoea index on the first postoperative night. Secondary outcomes were the supine apnoea-hypopnoea index on the third postoperative night, and the oxygen desaturation index on the first and third postoperative nights. Additional outcomes included intravenous morphine equivalent consumption and pain scores on postoperative days 1, 2 and 3. Pre-operative sleep study data were similar between groups. Mean (95%CI) values for the supine apnoeahypopnoea index on the first postoperative night were 18.9 (12.7-25.0) and 21.4 (14.2-28.7) events.h À1 , respectively, in the short-acting and standard anaesthesia groups (p = 0.64). Corresponding values on the third postoperative night were 28.1 (15.8-40.3) and 38.0 (18.3-57.6) events.h À1 (p = 0.34). Secondary sleep-and pain-related outcomes were generally similar in the two groups. In conclusion, short-acting anaesthetic agents did not reduce the impact of general anaesthesia on sleep apnoea severity compared with standard agents. These data should prompt an update of current recommendations.

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A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy

Cited by 32 publications

References 29 publications

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

The Relationship Between Postoperative Opioid Analgesia and Sleep Apnea Severity in Patients Undergoing Hip Arthroplasty: A Randomized, Controlled, Triple-Blinded Trial

Impact of short‐acting vs. standard anaesthetic agents on obstructive sleep apnoea: a randomised, controlled, triple‐blind trial

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