Comparison of Ultrasound‐Guided Type‐II Pectoral Nerve Block and Rhomboid Intercostal Block for Pain Management Following Breast Cancer Surgery: A Randomized, Controlled Trial

Abstract

Although breast-conserving surgery-axillary dissection (BCS-AD) is a minimally invasive surgery, patients may suffer from moderate-to-severe pain. Several regional techniques can be used for pain control. The type II pectoral nerve block (PECS II) and the rhomboid intercostal block (RIB) are interfascial plane blocks that have been reported to provide effective analgesia after breast surgery. This study aims to compare the analgesic efficacy of the PECS II block and the RIB after breast surgery.Patients and Methods: Ninety female patients aged 18 to 65 years with American Society of Anesthesiologists (ASA) classes I and II physical status who underwent unilateral BCS-AD surgery were included. Patients were divided into three groups (n = 30 in each): the PECS II group, the RIB group, or the control group. PECS II block and RIB were performed with 30 mL 0.25% bupivacaine. Ibuprofen 400 mg IV 3 9 1 was given in the postoperative period. A patient control analgesia device included a dose of 10 µg/mL fentanyl, which was prepared and connected to the patients. Results: There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the PECS II and RIB groups than the control group. The need for rescue analgesia use was significantly higher in the control group than the other groups. At all times, visual analog scale scores were significantly lower in the PECS II and RIB groups than the control group. Conclusions: The PECS II block and the RIB provide similar effective analgesia after BCS-AD. &

Efficacy and safety of rhomboid intercostal block for analgesia in breast surgery and thoracoscopic surgery: a meta-analysis

“…Two trials [ 17 , 18 ] compared RIB with no block. One trials [ 15 ] compared RIB both to no block and to RIB combined with sub‑serratus plane block, and one trials [ 16 ] compared RIB both to no block and to Type-II pectoral nerve block. Their results were analyzed separately.…”

“…For postoperative pain scores, three studies used NRS scores [ 15 , 17 , 18 ] and one used VAS scores [ 16 ]. Since the NRS score was consistent with the VAS score, the VAS score value was converted to the NRS score value for comparison [ 13 , 14 ].…”

“…Compared with no block, RIB showed a significant lower NRS at resting time of 0–1 h (WMD = -1.08; 95% CI = -1.98 to -0.18; p < 0.05) and there was significant heterogeneity among the studies (I 2 = 93%, heterogeneity p < 0.0001). Meanwhile, two other studies [ 16 , 18 ] performed breast surgery and were set as subgroup 2. It showed a significant reduction in NRS at rest in RIB group during the initial 0–1 h resting period (WMD = -3.00; 95% CI = -3.13 to -2.87; p < 0.0001).…”

“…Compared to no block group, RIB showed a lower NRS at rest time of first 6–8 h, but no significant (WMD = -0.50; 95% CI = -1.48 to 0.48; p = 0.32) and there was significant heterogeneity among the studies (I 2 = 99%, heterogeneity p < 0.0001). Meanwhile, two other studies [ 16 , 18 ] performed breast surgery and were classified as subgroup 2. It also showed a reduction in NRS at rest in those who received RIB during the 6–8 h resting period but no significant (WMD = -0.89; 95% CI = -1.87 to 0.09; p = 0.08) with significant heterogeneity among the studies (I 2 = 96%, heterogeneity p < 0.…”

“…The heterogeneity was no applicable. Meanwhile, two other studies [ 16 , 18 ] performed breast surgery and were classified as subgroup 2. It also showed significant reduction in NRS at rest in those who received RIB at resting time of first 24 h (WMD = -1.17; 95% CI = -1.32 to -1.01; p < 0.…”