Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study

Weaver, Tristan; Villalobos, Marco Echeverria; Periel, Luis; Pasek, Joshua; Fiorda-Diaz, Juan; Palettas, Marilly; Skoracki, Roman J.; Poteet, Stephen J.; Heard, Jarrett

doi:10.3389/fmed.2022.975080

Cited by 5 publications

(14 citation statements)

References 65 publications

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“…Since the first publication by Blanco in 2011, several studies have examined the benefits of IPP/PSP [ 4 , 21 , 33 ]. Recently published PROSPECT guidelines [ 34 ] recommend administration of regional anesthesia for major breast surgery.…”

Section: Discussionmentioning

confidence: 99%

Interpectoral and Pectoserratus Plane Block vs. Local Anesthetic Infiltration for Partial Mastectomy: A Prospective Randomized Trial

Eisler,

Zimmermann,

Henningsson

2024

Pain Research and Management

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Background. Patients undergoing breast surgery are at risk of severe postoperative pain. Several opioid-sparing strategies exist to alleviate this condition. Regional anesthesia has long been a part of perioperative pain management for these patients. Aim. This randomized study examined the benefits of interpectoral and pectoserratus plane block (IPP/PSP), also known as pectoralis nerve plain block, compared with advanced local anesthetic infiltration. Methods. We analyzed 57 patients undergoing partial mastectomy with sentinel node dissection. They received either an ultrasound-guided IPP/PSP block performed preoperatively by an anesthetist or local anesthetic infiltration performed by the surgeon before and during the surgery. Results. Pain measured with the numerical rating scale (NRS) indicated no statistically significant difference between the groups (IPP/PSP 1.67 vs. infiltration 1.97; p value 0.578). Intraoperative use of fentanyl was significantly lower in the IPP/PSP group (0.18 mg vs 0.21 mg; p value 0.041). There was no statistically significant difference in the length of stay in the PACU (166 min vs 175 min; p value 0.51). There were no differences in reported postoperative nausea and vomiting (PONV) between the groups. The difference in postoperative use of oxycodone in the PACU (p value 0.7) and the use of oxycodone within 24 hours postoperatively (p value 0.87) was not statistically significant. Conclusions. Our study showed decreased intraoperative opioid use in the IPP/PSP group and no difference in postoperative pain scores up to 24 hours. Both groups reported low postoperative pain scores. This trial is registered with NCT04824599.

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Section: Discussionmentioning

confidence: 99%

Interpectoral and Pectoserratus Plane Block vs. Local Anesthetic Infiltration for Partial Mastectomy: A Prospective Randomized Trial

Eisler,

Zimmermann,

Henningsson

2024

Pain Research and Management

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“…Postoperative opioid use in the intervention groups showed a decrease in opioid consumption in the first 24 hours in 93.3% of the included articles (N = 14) [ 3 , 5 , 6 , 9 , 10 - 19 ], and 6.6% (N = 1) showed no difference in postoperative opioid consumption [ 4 ].…”

Section: Reviewmentioning

confidence: 99%

“…Postoperative pain levels in the intervention groups showed a decrease in patient-reported pain scores in 86.6% of the included articles (N = 13) [ 3 , 5 , 9 - 19 ], whereas 6.6% (N = 1) showed an increase in reported pain scores [ 6 ] and 6.6% (N = 1) showed no difference [ 4 ].…”

Section: Reviewmentioning

confidence: 99%

“…Most studies showed a statistically significant decrease in postoperative opioid consumption and patient-reported pain scores [ 3 , 5 , 9 - 19 ]. One study showed no difference in postoperative opioid consumption [ 4 ], and another showed an increased opioid consumption [ 6 ]. The authors of this article suspect that part of the discrepancy in Maxim Roy’s trial is due to the unusual method of administering local anesthetic with the block on one side and a sham block (0.9% NaCl) on the other side making each patient their own control group, on top of the low number of patients included in their study (N = 19).…”

Section: Reviewmentioning

confidence: 99%

“…These surgeries are accompanied by significant pain and have a high incidence of chronic pain postoperatively, even following minor procedures [ 2 ]. Poor management of perioperative pain can lead to chronic pain, psychological trauma, reduced quality of life, as well as delayed functional recovery, and post-anesthesia care unit discharge [ 3 , 4 ]. Regional blocks have been implemented in the perioperative setting to provide superior pain control.…”

Section: Introductionmentioning

confidence: 99%

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The Pectoral (PECS) Regional Block: A Scoping Review

Bin Ghali,

AlKharraz,

Almisnid

et al. 2023

Cureus

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Among the various surgical procedures, breast surgeries rank as a frequently conducted procedure. Interfacial blocks such as the Pectoral (PECS) block became possible with the currently available knowledge on innervations and ultrasound. Interfacial blocks target the deep fascial planes, which are potential spaces for injecting local anesthetics. The Pectoral I (PECS I) consists of the injection of local anesthetics in the plane between the pectoralis major and minor muscles. The PECS II block, a modified version of the block, is achieved by adding another, deeper injection in the plane between the pectoralis minor and the serratus anterior muscle. We conducted a scoping review using Arkesy and O’Malley's framework, as described by Levac. We identified our research question as the uses of the PECS regional block technique with the choice of local anesthetics, including adjuncts, and its effectiveness in intraoperative and postoperative analgesia in the first 24 hours and incidence of postoperative nausea and vomiting. Subsequently, we identified the relevant studies that met our inclusion criteria and charted the data. Lastly, we summarized and reported the results. The PECS block was used in various breast surgeries, among which radical mastectomies with/without lymph node dissection were the most common. It was found that the PECS block reduced intraoperative opioid consumption in 60% and 24-hour postoperative opioid consumption in 93.3% of the included papers. Various local anesthetics were used such as ropivacaine, bupivacaine, and levobupivacaine. Ultrasound-guided interfacial plane blocks, such as the PECS block, are a recent development in regional anesthesia that offers analgesia for patients undergoing breast surgeries. The authors conclude that PECS block can provide a decrease in intraoperative and postoperative opioid consumption, a decrease in the incidence of nausea and vomiting, and can lead to overall patient satisfaction in terms of lower pain scores compared to systemic analgesia.

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Efectividad Del Bloqueo Pec Ii Comparado Con Analgesia Endovenosa en Monodosis en Pacientes Post Mastectomia Por Cáncer De Mama

Santillan Rojas,

Caballero Alvarado

2024

Rev Peru Investig Matern Perinat

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Objective: To determine whether in post-mastectomy breast cancer patients, PEC II block plus single-dose intravenous analgesia is more effective than single-dose intravenous analgesia in treating postoperative pain. Methods: An cohort study was conducted between June and September 2022 with 60 breast cancer patients who underwent unilateral mastectomy. Two groups of 30 patients each were formed: one received PECS II Block plus EV Analgesia and the other only EV Analgesia. Inclusion criteria covered patients with ASA physical status 1 or 2, aged 18 to 70 years, and excluded those with drug allergies, serious diseases and those who refused to participate. Results: Patients who received EV Analgesia alone reported higher values of pain measured by the Visual Analog Scale compared to those who received PECS II Block plus EV Analgesia, with significant differences (p = 0.001). In terms of adverse effects, all patients in the PECS II Block and EV Analgesia group experienced no negative effects, while in the EV Analgesia only group, 100% required rescue analgesia, and there were reports of vomiting, headache and nausea. Conclusion: PECS II Block in combination with EV Analgesia proved to be more effective in postoperative pain control in patients undergoing unilateral mastectomy for breast cancer, significantly reducing the need for rescue analgesia and the occurrence of adverse effects compared to EV Analgesia alone.

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Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study

Cited by 5 publications

References 65 publications

Interpectoral and Pectoserratus Plane Block vs. Local Anesthetic Infiltration for Partial Mastectomy: A Prospective Randomized Trial

Interpectoral and Pectoserratus Plane Block vs. Local Anesthetic Infiltration for Partial Mastectomy: A Prospective Randomized Trial

The Pectoral (PECS) Regional Block: A Scoping Review

Efectividad Del Bloqueo Pec Ii Comparado Con Analgesia Endovenosa en Monodosis en Pacientes Post Mastectomia Por Cáncer De Mama

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