Assessing the efficacy of the S-PECS block in breast augmentation surgery – a randomised double-blind control trial

Abstract

Background: Postoperative acute and chronic pain following breast surgery is a common complication that needs resolving to allow for improved patient outcomes. Previously, thoracic epidurals and paravertebral blocks have been the accepted standard administered intraoperatively. However, more recently the introduction of the pectoral nerve block (PECS and PECS-2 blocks) has appeared promising to control the pain more effectively, but further robust analysis is required to prove its efficacy. The authors aim to study the efficacy of a new block, S-PECS, that combines a serratus anterior and a PECS-2 block. Methods: In this study, the authors performed a single-center, randomized, controlled, double-blind group trial in 30 female patients undergoing breast augmentation surgery with silicone breast implants and the S-PECS block. Divided into two groups of 15, the PECS group received local anesthetics and the no-PECS control group received a saline injection. All participants were followed up at recovery and at 4, 6, and 12 hours postoperatively. Results: The authors’ results showed that the pain score in the PECS group was significantly less than in the no-PECS group across all time points: recovery, and at 4, 6, and 12 hours. Furthermore, the patients who received the S-PEC block were 74% less likely to request pain medications compared with the no-PECS group (P < 0.05). Conclusion: Overall, the modified S-PECS block is an effective, efficient, and safe method of controlling pain in patients undergoing breast augmentation surgery, with additional applications yet to be explored.

The Reverse Dual Plane: A Novel Technique for Endoscopic Transaxillary Breast Augmentation

“…Most of the pectoral muscle is still held tight by the implant, and hence, patients have also complained about this pain. 7 , 12 How to further alleviate postoperative pain is still a significant problem to solve. 6-12 Compared with the other plane, this is the least degree of pain experienced after subglandular and subfascial implant placement, yet there are strict indications for these 2 planes.…”

Chronic Pain Following Breast Reconstruction

“…Regional nerve blocks can be used to relieve pain, including truncal regional anesthesia, pectoral nerve block, thoracic paravertebral block, serratus plane block, pecto-intercostal block, continuous paravertebral block, and pulsed radiofrequency 54,88–95 . Pectoral nerve block type II (PECS II block) can be used for safe pain relief following radical mastectomy, 90,91 and the opioid requirement for 24 hours after breast surgery is significantly lower with PECS II than without PECS II 96 .…”

“…Regional nerve blocks can be used to relieve pain, including truncal regional anesthesia, pectoral nerve block, thoracic paravertebral block, serratus plane block, pecto-intercostal block, continuous paravertebral block, and pulsed radiofrequency. 54,[88][89][90][91][92][93][94][95] Pectoral nerve block type II (PECS II block) can be used for safe pain relief following radical mastectomy, 90,91 and the opioid requirement for 24 hours after breast surgery is significantly lower with PECS II than without PECS II. 96 Postoperative abdominal pain is specific for abdominal autologous breast reconstruction, but regional anesthetic techniques such as TAP block have the potential to prevent chronic pain after breast reconstruction.…”

Effectiveness of a Novel Temperature-Responsive Hydrogel (PF72) for Postoperative Pain Relief in Breast Augmentation

“…Moreover, with increased risks of epidural bleeding, severe infection, post-dural puncture headaches, subdural blockade and neurological dysfunction, thoracic epidurals were recently replaced with the current gold standard paravertebral blocks. Although safer than the thoracic epidural, some risks remain with paravertebral blocks, such as hypotension, vascular or accidental pleural puncture, and epidural or intrathecal placement [ 10 ]. Pain control is an important aspect that can affect a patient’s morbidity and satisfaction, which in turn can have an influence on experience and, further, personal recommendation of this ambulatory cosmetic procedure and the surgeon themselves.…”