Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial

Altıparmak, Başak; Toker, Melike Korkmaz; Uysal, Ali İhsan; Turan, Mustafa; Demirbilek, Semra

doi:10.1016/j.jclinane.2018.10.040

Cited by 140 publications

(110 citation statements)

References 18 publications

Supporting

Mentioning

102

Contrasting

Unclassified

Order By: Relevance

“…Compared with PECS block, erector spinae plane block initially provided no difference in pain scores . But after the first postoperative hour, pain scores and opioid consumption were both lower in the PECS block group .…”

Section: Resultsmentioning

confidence: 76%

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 76%

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The 125 articles finally included in this review included: 6 randomized controlled trials [104][105][106][107][108][109], 1 consecutive controlled before-and-after study [110], 2 observational studies [111,112], 3 review articles [2,113,121], 5 anatomical studies [3][4][5]124,125], 98 case reports [1,, and 10 opinion articles [6,[114][115][116][117][118][119][120][122][123][124][125][126]. The case reports are described in Table 1 [1,.…”

Section: Resultsmentioning

confidence: 99%

“…The NRS scores and the requirement for additional analgesia were statistically significantly lower in the ESP group. Altiparmak et al [107] compared the effects of modified pectoral nerve (PECS) block and ESP block after radical mastectomy surgery. They concluded that PECS block reduced postoperative tramadol consumption (132.78 ± 22.44 mg vs. 196.00 ± 27.03 mg) and NRS scores after the postoperative 1 h, 2 h, 12 h, and 24 h more effectively than the ESP block.…”

Section: Resultsmentioning

confidence: 99%

The erector spinae plane block: a narrative review

Kot

Rodríguez

Granell

et al. 2019

Korean J Anesthesiol

206

146

View full text Add to dashboard Cite

Regional anesthesia and pain management have experienced advances in recent years, especially with the advent of fascial plane blocks. The erector spinae plane block is one of the newest techniques to be described. In the past two years, publications referring to ESP block have increased significantly. The objective of this review is to analyze the articles about ESP block that have been published to date. We performed a search in the main databases and identified 368 articles. After a selection of the relevant articles, 125 studies were found eligible and were included in the review. The ESP block is performed by depositing the local anesthetic in the fascial plane, deeper than the erector spinae muscle at the tip of the transverse process of the vertebra. Many cases of its use have been described with satisfactory results in the treatment of both acute pain and chronic pain. The applicability of the technique covers many clinical scenarios. Of the 98 case reports reviewed, 12 and 87 articles, respectively described the technique as a treatment for chronic pain and acute pain. The single-shot was the most frequently used technique. As described in the articles published to date, the technique is easy to perform and has a low rate of complications. However, despite the effectiveness of the technique, further studies are necessary to obtain more evidence of its actions.

show abstract

“…In Fang et al's study, blood pressure was also lower in the ESP B group than in the TPVB group, which was statistically significant (18). In the study of Altiparmak et al, the mean arterial blood pressure was similar in both groups (20).…”

Section: Discussionmentioning

confidence: 83%

Pectoral Nerve Block and Erector Spinae Plane Block and Post-Breast Surgery Complications

et al. 2020

View full text Add to dashboard Cite

Background: The use of regional methods in various types of surgery such as mastectomy is very popular today. Various methods, including Pecs I-II block, erector spinae, epidural thoracic, and paravertebral block have been used in these operations, each with its own advantages and disadvantages. Recent studies on the effect of µ receptor stimulation on the likelihood of recurrence and metastasis have been published, which make the use of a suitable regional approach with low complications and high efficacy attractive. Among the side effects of breast surgery in patients with cancer are nausea and vomiting, the risk of which is reduced through regional procedures that reduce the need for opioids. Methods: We randomly divided 64 patients into two pectoralis block (Pecs B) and erector spinae block (ESB) groups. Visual analogue scale (VAS) scores at 2, 4, 6, and 10 hours, nausea and vomiting, need for opioids, and hemodynamic changes were recorded. Results: The analyses showed that pain score was significantly higher in the Pecs B group compared to the ESB group, while VAS score, as well as the frequency of opioid use, were lower, which could be due to medial branch of the anterior intercostal nerve. Hemodynamic changes were also significantly greater in the ESB group, which could be due to the proximity of the block to the thoracic sympathetic nerves and spinal cord. Conclusions: Despite the statistically significant differences in analgesia and hemodynamic changes, the seemingly superiority of the Pecs B is not clinically significant and the use of both types of the block is selective. Regarding the need for opioids and nausea, Pecs B showed a tangible advantage over ESB.

show abstract

Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial

Cited by 140 publications

References 18 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 erector spinae plane block: a narrative review

Pectoral Nerve Block and Erector Spinae Plane Block and Post-Breast Surgery Complications

Contact Info

Product

Resources

About