Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial

Kulhari, Sunita; Bharti, Neerja; Bala, Indu; Arora, Saurabh; Singh, Gurpreet

doi:10.1093/bja/aew223

Cited by 225 publications

(202 citation statements)

References 13 publications

(10 reference statements)

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“…Many refinements of the initial pectoral nerve block have recently been published without proper testing of the initial Pecs I. Some clinical data seem to prove the efficiency of Pecs blocks, [14][15][16][17] but no prospective randomized controlled trial has compared Pecs I with a placebo.…”

mentioning

confidence: 99%

Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery

Cros

Sengès

Kaprelian

et al. 2018

Regional Anesthesia and Pain Medicine

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mentioning

confidence: 99%

Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery

Cros

Sengès

Kaprelian

et al. 2018

Regional Anesthesia and Pain Medicine

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“…Alternatively, targeted infusions could be performed with paraverterbal, pectoralis or serratus anterior nerve blocks. This has shown promise in reducing post-operative mastectomy pain [10,11]; however, to our knowledge, this has not been explored in women undergoing autologous reconstruction or investigated in concert with a TAP block.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Liposomal Bupivacaine for Pain Management after Immediate and Delayed Deep Inferior Epigastric Perforator Free Flap Reconstruction

Knackstedt¹,

Gatherwright²,

Ghaznavi³

et al. 2018

J Aesthet Reconstr Surg

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Patient analgesia can be addressed pre, intra and postoperatively. The utilization of local anesthetics administered intra-operatively is limited by the medication's short duration of action. However, an intraoperative transversus abdominis plane (TAP) block can be utilized to anesthetize the T6-L1 intercostal nerves that supply the anterior abdominal wall. This provides analgesia to the abdominal wall, which has been identified as the largest source of post-operative pain following abdominally-based autologous tissue breast reconstruction.

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“…These demonstrate that the Pecs blocks are associated with lower pain scores and opioid sparing effects compared to placebo [35,36]. Comparing the Pecs blocks with single thoracic paravertebral injections has produced conflicting efficacy results [37,38]. Potential complications following these blocks include pneumothorax and injury to the thoracodorsal artery.…”

Section: Evidence and Clinical Applicationsmentioning

confidence: 99%

Ultrasound-guided truncal blocks for perioperative analgesia

Koh

Lee

2018

Anesth Pain Med

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Since the widespread introduction of ultrasound for assisting techniques used in anesthetic theatres, peripheral nerve blocks of the trunk have been used more frequently to produce analgesia and anesthesia for surgeries involving the thorax, abdomen, and lower extremities. The introduction of real-time ultrasound has allowed the peripheral nerves, planes, and plexuses of the trunk to be located more accurately and has improved the success rate of truncal blocks The widespread application of ultrasound in clinical anesthesiology has led to an increase in the number of practitioners performing peripheral nerve blocks of the trunk to produce analgesia and anesthesia for surgeries involving the thorax, abdomen, and lower extremities. The use of real-time ultrasound has allowed the peripheral nerves, planes, and plexuses of the trunk to be located more accurately and has improved the success rate of blocks. Compared to central neuraxial techniques, many types of truncal blocks are relatively easy to perform and have low side effect profiles. As a result, truncal blocks have been introduced to provide perioperative analgesia for surgeries involving the thorax and abdomen. The most frequently used truncal block techniques include the paravertebral block, intercostal block, pectoralis and serratus anterior block, rectus sheath block, transversus abdominis plane block, and ilioinguinal and iliohypogastric nerve blocks. Recently introduced techniques also include the quadratus lumborum and erector spinae plane blocks. To apply each block correctly and reduce the likelihood of related side effects and complications, the practitioner must have a thorough understanding of the anatomical region, optimal block positioning, and device selection and management.

show abstract

Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial

Abstract: CTRI/2014/06/004692.

Cited by 225 publications

References 13 publications

Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery

Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery

Comparison of Liposomal Bupivacaine for Pain Management after Immediate and Delayed Deep Inferior Epigastric Perforator Free Flap Reconstruction

Ultrasound-guided truncal blocks for perioperative analgesia

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