<p>Rasternal Intercostal Block Complementation Contributes to Postoperative Pain Relief in Modified Radical Mastectomy Employing Pectoral Nerve Block I and Serratus-Intercostal Block: A Randomized Trial</p>

Abstract

Purpose: Pectoral nerve block I (PECS I) and serratus-intercostal plane block (SIPB) can anesthetize the majority mammary region, while parasternal intercostal block (PSI) targets the internal area during breast resection surgery. The aim of this study was to determine whether including PSI with PECS I and SIPB is more effective compared to PECS I and SIPB alone. Patients and Methods: Sixty-two adult females undergoing unilateral modified radical mastectomy (MRM) were randomly assigned to receive either PECS I and SIPB (PS group, n=31) or a combination of PECS I, SIPB, and PSI (PSP group, n=31). The outcomes were measured with a numerical rating scale (NRS) score, and in terms of opioid consumption and anesthesia-related complications within 48 h after surgery. Results: Although there were no differences in the NRS scores between the two groups during the inactive periods, the combination of three nerve blocks significantly reduced the NRS scores during movement. In addition, morphine equivalent consumption was lower in the PSP group compared to the PS group. Postoperative adverse events were similar in both groups in terms of regional anesthesia-related complications. Conclusion: The combination of PECS I block, SIPB, and PSI block provides superior pain relief and postoperative recovery for patients undergoing MRM.

Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy: a randomized, double-blind, placebo-controlled trial

“…Patients administered USG parasternal intercostal nerve block reported significantly lower pain scores and higher satisfaction toward analgesia compared with those treated with sufentanil PCIA alone. Parasternal intercostal nerve block with ropivacaine has been successfully employed for pain management in cardiac surgery [ 7 – 10 ] and our previous study [ 15 , 21 ], consistent with the present results. Regardless, evaluating the analgesic efficacy of USG parasternal intercostal nerve block with ropivacaine in patients undergoing mediastinal mass resection by median sternotomy was firstly performed in this study.…”

Efficacy and Safety of Pectoral Nerve Block (Pecs) Compared With Control, Paravertebral Block, Erector Spinae Plane Block, and Local Anesthesia in Patients Undergoing Breast Cancer Surgeries

“…Twenty-two of them were excluded. Finally, 37 studies were included in the quantitative synthesis,9,10,17–19,24–55 and 47 studies were included in the qualitative synthesis9,10,17–19,24–65 (Fig. 1).…”

“…However, Pecs II block is not clinically significant, and both types (Pecs II and ESPB) are selective. 62 Song et al 64 revealed that the combination of Pecs I block, SPB, and parasternal intercostal block significantly lowered the NRS pain scores through movement. In addition, the parasternal intercostal block reduced consumption of morphine than the Pecs I with SPB (P < 0.001) but showed no significant difference regarding the incidence of nausea (P = 0.783) and vomiting (P = 0.755).…”

Dual Pectoral Nerve and Serratus Anterior Blocks for Postoperative Analgesia After Breast Surgery: Placebo-Controlled Comparative Study Versus Paravertebral Block

“…In addition to these advantages, Wang et al [34] found such combination contributed to better sleep quality and higher patient satisfaction of pain relief and Grasso et al [35] found the combined blocks significantly reduced PONV and hospital stay. In an interesting comparative study, Song et al [36] found the combination of PECS, SAB and parasternal intercostal blocks showed no differences in pain scores in comparison to PECS/SAB alone during rest but significantly reduced pain scores during activity.…”