Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy: A randomised double-blind trial

Abstract

Background and Aims:Paravertebral block, pectoral nerve (Pecs) block and wound infiltration are three modalities for post-operative analgesia following breast surgery. This study compares the analgesic efficacy of these techniques for post-operative analgesia.Methods:Sixty-five patients with American Society of Anesthesiologists’ physical status 1 or 2 undergoing modified radical mastectomy with axillary dissection were recruited for the study. All patients received 21 mL 0.5% bupivacaine with adrenaline in the technique which was performed at the end of the surgery prior to extubation. Patients in Group 1 (local anaesthetic [LA], n = 22) received infiltration at the incision site after surgery, Group 2 patients (paravertebral block [PVB], n = 22) received ultrasound-guided ipsilateral paravertebral block while Group 3 patients [PECT] (n = 21) received ultrasound-guided ipsilateral Pecs blocks I and II. Patients were evaluated for pain scores at 0, 2, 4, 6, 12 and 24 h, duration of post-operative analgesia and rescue analgesic doses required. Non-normally distributed data were analysed using the Kruskal-Wallis test and Analysis of variance for normal distribution.Results:The post-operative visual analogue scale scores were lower in PVB group compared with others at 0, 2, 4, 12 and 24 h (P < 0.05). Mean duration of analgesia was significantly prolonged in PVB group (P < 0.001) with lesser rescue analgesic consumption up to 24 h.Conclusion:Ultrasound-guided paravertebral block reduces post-operative pain scores, prolongs the duration of analgesia and decreases demands for rescue analgesics in the first 24 h of post-operative period compared to ultrasound-guided Pecs block and local infiltration block.

Intraoperative pectoral nerve block (Pec) for breast cancer surgery: A randomized controlled trial

“…Currently, an increase in usage of peripheral nerve blocks as a part of comprehensive anaesthesia care regimens is seen. [ 4 ] Even single-shot regional techniques seem to give excellent early analgesia. [ 5 ] Blocking the sensory supply to breast, axilla, and over the pectoral muscles provides adequate analgesia in the postoperative period.…”

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

“…Anyway, the regional techniques and the wound infiltration have shown to be effective in reducing the acute postoperative pain, which is one of the predisposing factors for the development of persistent pain. 86,94,95 However, such results need to be confirmed by larger and well-designed randomized trials.…”

Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: Review of literature

“…Table 2 summarises the articles included, technique of fascial plane block used and the main outcome related to it. [ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ]…”