Intraoperative pectoral block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: A randomized controlled trial

Abstract

Background and Methods With the increasing rate of breast cancer surgery, the pain management of these patients gains importance. The aim of this study is to compare the ultrasound (US) guided thoracic paravertebral block (TPV) versus intraoperative pectoral nerve block (PECS) with a low volume local anaesthetic for postoperative analgesia after breast cancer surgery. A total of 41 patients underwent mastectomy and sentinel lymph node biopsy or modified radical mastectomy were included in this randomized controlled, single‐blinded trial. The patients were divided into two groups as PECS and TPV blocks. In the PECS group, 10 ml of 0.5% bupivacaine was administered to the fascial plane by the surgeon. In the TPV group, 25 ml of 0.25% bupivacaine at T3 level was administered by the anaesthetist under US‐guidance. Visual analogue scale (VAS) scores and additional analgesic requirements were recorded at postoperative 0, 6, 12, 24 and 48 h. Results In the TPV group, mean VAS score (VAS0) was significantly lower (p ˂ 0.001). In other time periods, there was no significant difference between the groups. Conclusions It was observed that intraoperative PECS block was as effective as TPV in providing postoperative analgesia and additional analgesic requirements were similar. This result suggests PECS block may be a good alternative to TPV.

Comparing analgesic efficacy of different block modalities after breast cancer surgery

“…We noted that this additional analgesic dose in the Kulhari et al study actually is the total intravenous mg morphine consumption for postoperative pain control in 24 h and a 30% expected between-group difference is used for sample size calculation. In the study of Sagun et al, 1 however, additional analgesics were intravenous mg nonsteroid anti-inflammatory drug and meperidine. Furthermore, this study compared the between-group differences in total mg doses of additional analgesic drugs in the first 48 h postoperatively.…”

“…To the Editor, In a prospective, randomized single-blind clinical study with a small sample size including 41 patients who underwent mastectomy and sentinel lymph node biopsy or modified radical mastectomy, Sagun et al 1 compared postoperative analgesic efficacy of pectoral block and thoracic paravertebral block. They showed that the two blocks were comparable with respect to postoperative analgesia and additional analgesic requirements.…”