Analgesic efficacy of the Pecs II block: a systematic review and meta‐analysis

Abstract

SummarySurgery is the primary therapeutic intervention for breast cancer and can result in significant postoperative pain. We searched the current literature and performed a meta‐analysis in order to compare the analgesic efficacy of the pectoral type‐2 (Pecs II) block with systemic analgesia alone and with a thoracic paravertebral block for breast cancer surgery. Primary outcome was postoperative opioid consumption in the first 24 h after surgery. Secondary outcomes were pain scores at 0, 3, 6, 9 and 24 h after surgery, intra‐operative opioid consumption, time to first analgesic request and incidence of postoperative nausea and vomiting. We identified 13 randomised controlled trials that included 815 patients. The Pecs II block significantly reduced postoperative opioid consumption (standardised difference in means: −13.64 mg oral morphine equivalents; 95%CI: −21.22 to −6.05; p < 0.01) and acute postoperative pain at all intervals in the first 24 h after surgery compared with systemic analgesia alone. Compared with the thoracic paravertebral block, the Pecs II block resulted in similar postoperative opioid consumption (standardised difference in means: −8.73 mg oral morphine equivalents; 95%CI: −18.16 to 0.69; p = 0.07) and postoperative pain scores after first measurement. In conclusion, the Pecs II block offers improved analgesic efficacy compared with systemic analgesia alone and comparable analgesic efficacy to a thoracic paravertebral block for breast cancer surgery.

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

“…Two meta‐analyses comparing PECS to paravertebral blocks reported similar results on pain reIief and analgesia consumption . A third meta‐analysis also demonstrated the efficacy of PECS blocks to reduce pain and morphine consumption when compared with no block or placebo .…”

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

“…The PECS 2 block reduced median (IQR [range]) morphine consumption in the first 24 h from 6 (3-9 [1-25]) mg after the serratus plane block to 4 (2-7 [0-37]) mg, p = 0.04. However, acute pain scores after serratus plane and PECS 2 blocks were similar, median (IQR [range]) 23 [0-70]) mm vs. 18 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) [0-61]) mm, respectively, p = 0.44.…”

“…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.…”

“…Both thoracic interfascial plane blocks reduce acute pain after mastectomy [20][21][22][23][24][25][26]. However, the long-term analgesic effects remain unclear.…”

Clarification on chronic pain – a painfully persistent problem?

“…It is worthwhile discussing that at 24 h postoperatively, it is expected that pain levels would be comparable between both groups. This is because the effect of 30 ml ropivacaine 0.5% without the use of adjuncts, injected as a single shot inter‐fascial plane block, would be negligible after 24 h . Additionally, the authors do not discuss the fact that the rates of pain‐free women were initially lower (25% vs. 48%) following serratus plane block, while the incidence of chronic pain was higher (33% vs. 10%).…”