Analgesic and Sensory Effects of the Pecs Local Anesthetic Block in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study

Wijayasinghe, Nelun; Andersen, Kenneth Geving; Kehlet, Henrik

doi:10.1111/papr.12423

Cited by 24 publications

(20 citation statements)

References 28 publications

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“…These blocks are effective for acute postmastectomy pain [20][21][22][23][24][25][26] and improve persistent postmastectomy pain [29,30]. However, it is uncertain which block is more effective.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of pectoral nerve‐2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

et al. 2019

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Thoracic interfascial plane blocks are effective for post-mastectomy acute analgesia. However, their effects on chronic pain are uncertain. We randomly allocated 80 women equally to pectoral nerve-2 (PECS 2) block or serratus plane block. The pectoral nerve-2 block reduced the rate of moderate or severe chronic pain from 13/ 40 (33%) with the serratus plane block to 4/40 (10%), p = 0.03, adjusted odds ratio (95%CI) 0.23 (0.07-0.80), p = 0.02. The rates of pain-free women at six postoperative months were indeterminate, 10/40 (25%) after serratus plane block vs. 19/40 (48%) after pectoral nerve-2 block, p = 0.06, adjusted odds ratio (95%CI) 2.9 (1.1-7.5), p = 0.03. Health-related quality of life at six postoperative months was similar after serratus plane and pectoral nerve-2 blocks, mean (SD) EQ-5D-3L scores 0.87 (0.15) vs. 0.91 (0.14), respectively, p = 0.21. The pectoral nerve-2 block reduced median (IQR [range]) morphine consumption in the first 24 postoperative hours from 6 (3-9 [1-25]) mg to 4 (2-7 [0-37]) mg, p = 0.04. However, acute pain scores after serratus plane and pectoral nerve-2 blocks were similar, median (IQR [range]) 23 (11-35 [0-70]) mm vs. 18 (11-27 [0-61]) mm, respectively, p = 0.44. Pectoral nerve-2 block reduced chronic pain 6 months after mastectomy compared with serratus plane block.

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Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of pectoral nerve‐2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

et al. 2019

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“…At a fundamental level, published literature suggests that the wider surgical community may not understand the concept of PFS, with evidence of small, underpowered RCTs often mislabelled as pilot or feasibility studies. Such studies often fail to address baseline feasibility issues such as considering whether a main trial is possible, and instead focus on formal hypothesis testing. Further work is therefore needed to understand when and how PFS may be used optimally to inform future main trials in surgery.…”

Section: Introductionmentioning

confidence: 99%

Value of surgical pilot and feasibility study protocols

Fairhurst

Blazeby

Potter

et al. 2019

British Journal of Surgery

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Background RCTs in surgery are challenging owing to well established methodological issues. Well designed pilot and feasibility studies (PFS) may help overcome such issues to inform successful main trial design and conduct. This study aimed to analyse protocols of UK‐funded studies to explore current use of PFS in surgery and identify areas for practice improvement. Methods PFS of surgical interventions funded by UK National Institute for Health Research programmes from 2005 to 2015 were identified, and original study protocols and associated publications sourced. Data extracted included study design characteristics, reasons for performing the work including perceived uncertainties around conducting a definitive main trial, and whether the studies had been published. Results Thirty‐five surgical studies were identified, of which 29 were randomized, and over half (15 of 29) included additional methodological components (such as qualitative work examining recruitment, and participant surveys studying current interventions). Most studies focused on uncertainties around recruitment (32 of 35), with far fewer tackling uncertainties specific to surgery, such as intervention stability, implementation or delivery (10 of 35). Only half (19 of 35) had made their results available publicly, to date. Conclusion The full potential of pretrial work to inform and optimize definitive surgical studies is not being realized.

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“…In 2016, a small (n=6) pilot study in women with CPOP in the axilla, upper arm, or lateral chest wall between 1 and 7 years after breast surgery demonstrated at least a mild analgesic effect following local anesthetic blockade of the intercostobrachial nerve that lasted for 7 days in half of the patients 50 . In 2017, another small (n=8) pilot study in women with CPOP between 7 and 84 months after breast surgery demonstrated an analgesic effect that lasted for 7 days following local anesthetic blockade of the pectoral nerves 51 . While promising, both of these regional techniques require much larger, randomized controlled trials to determine their true benefits.…”

Section: Treatmentmentioning

confidence: 99%

Chronic postoperative pain: recent findings in understanding and management

Correll

2017

F1000Res

108

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Chronic postoperative pain is a poorly recognized potential outcome from surgery. It affects millions of patients every year, with pain lasting for months to years, resulting in patient suffering and ensuing economic consequences. The operations with the highest incidence of chronic postoperative pain are amputations, thoracotomies, cardiac surgery, and breast surgery. Other risk factors include preoperative pain, psychological factors, demographics, and the intensity of acute postoperative pain. Attempts to prevent chronic postoperative pain have often led to debatable results. This article presents data from recently published studies examining the incidence, risk factors, mechanisms, treatment options, and preventive strategies for chronic postoperative pain in adults. In summary, many of the previously identified risk factors for chronic postoperative pain have been confirmed and some novel ones discovered, such as the importance of the trajectory of acute pain and the fact that catastrophizing may not always be predictive. The incidence of chronic postoperative pain hasn’t changed over time, and there is limited new information regarding an effective preventive therapy. For example, pregabalin may actually cause more harm in certain surgeries. Further research is needed to demonstrate whether multimodal analgesic techniques have the best chance of significantly reducing the incidence of chronic postoperative pain and to determine which combination of agents is best for given surgical types and different patient populations.

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Analgesic and Sensory Effects of the Pecs Local Anesthetic Block in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study

Abstract: This pilot study suggests that the pectoral nerves play a role in the maintenance of pain in the breast area in PPBCS and begs for further research.

Cited by 24 publications

References 28 publications

A randomised controlled trial of pectoral nerve‐2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

A randomised controlled trial of pectoral nerve‐2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

Value of surgical pilot and feasibility study protocols

Chronic postoperative pain: recent findings in understanding and management

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