Pectoral block versus paravertebral block: a systematic review, meta-analysis and trial sequential analysis

Abstract

BackgroundPectoral (PECs) block was first described by Blanco et al for postoperative analgesia in breast surgery. It was proposed to be an easier and safer alternative to thoracic epidural or paravertebral block (PVB). In this systematic review and meta-analysis, we compare the perioperative analgesic efficacy and adverse events of PECs block and PVB.MethodsWe systematically searched PubMed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, US clinical trials register, Wanfang database, as well as recent conference abstracts, for clinical studies comparing the two techniques. Analgesic efficacy was assessed according to the time to first rescue analgesia and 24 hours opioid consumption. Adverse events from the trials were recorded and reported descriptively.ResultsThe literature search was last updated on 20 February 2020. We identified a total of 10 randomized controlled trials (RCTs) comparing PECs to PVB with 252 and 250 patients, respectively. There was no difference in 24 hours opioid consumption between PECs and PVB. There was no significant difference in the time to rescue analgesia between the two cohorts. The most common adverse event noted was postoperative nausea and vomiting). Trial sequence analysis indicate that further studies are unlikely to alter the conclusion regarding opioid requirement.ConclusionOur systematic review suggests that PECs and PVB are comparable in postoperative analgesia efficacy for mastectomy, and further studies are unlikely to alter the conclusion. The choice of technique should, therefore, be based on practitioner skill and institutional guidelines.PROSPERO registration numberCRD42020165137.

A randomised trial: effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy

“…In the past, general anesthesia was often used, but the transmission of surgical trauma to the central nervous system could not be completely blocked, and it was difficult to meet the ideal anesthesia requirements (4). In recent years, the studies have shown that transversus thoracic muscle plane-pectoral nerves (TTP-PECS) block has a significant anesthesia effect on radical mastectomy and can stabilize hemodynamics (5,6). PECS block can provide anesthesia in the region of the lateral breast, blocking the cutaneous branches of the intercostal brachial nerve, the lateral intercostal nerve, the long thoracic nerve, and the thoracic dorsal nerve; however, it cannot block the medial breast region.…”

Ultrasound-Guided Thoracic Paravertebral Block Enhances the Quality of Recovery After Modified Radical Mastectomy: A Randomized Controlled Trial

“… 20 A systematic review also suggests that pectoral nerve block and TPVB are comparable in postoperative analgesia efficacy for mastectomy. 21 Consequently, the choice of regional anesthesia technique will depend on physician experience and institutional policy. The TPVB provides potent analgesia via blockade of the dorsal rami, and ventral rami emerge from the spinal canal.…”

Impact of adding opioids to paravertebral blocks in breast cancer surgery patients: A systematic review and meta-analysis

“…Over the last decade, several quality-improvement protocols have been described to improve peri-operative management and optimize pain control in breast cancer patients[ 7 ]. One such method is the use of locoregional anesthetic techniques like the paravertebral block (PVB), intercostal nerve block, erector spinae plane block, and pectoral block[ 5 , 8 , 9 ]. Of these, the PVB has been widely used to provide better analgesia after surgery in breast cancer patients.…”