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

Abstract

This study was registered at ClinicalTrials.gov, identifier NCT01670448.

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction.

“…Regional anesthetic techniques were performed ten times: the most common procedure was pectoralis nerve (Pecs) block type I and II (5 studies:Cros et al, 2018;Neethu et al, 2018;Versyck et al 2017;Wang et al, 2018;Wang et al, 2019), followed by serratus plane block (SPB) (2 studies:Wang et al, 2019;Yao et al, 2019), erector spinae plane (ESP) block(Gürkan et al, 2018), and paravertebral block (PVB)(Ilfeld et al, 2014).In Lanier et al 2018, intraoperative nerve blocks of intercostal and pectoral nerves were performed under direct visualization by the attending plastic surgeon at the completion of the mastectomy. Local infiltration was reported in 3 studies.…”

Erector Spinae Plane Block for Open-Heart Surgery: A Potential Tool for Improved Analgesia

“…The PECS I (pectoralis fascial) block results in analgesia of the medial and lateral pectoral nerves, which is of limited use in isolation. 2 The PECS II injection is more lateral and additionally blocks the upper intercostal nerves via the lateral cutaneous branch, providing a potentially larger area of lateral chest wall analgesia. A further modification is the serratus anterior plane block, which again blocks the lateral chest wall via the same nerves and has shown promising results for thoracic surgery.…”

Reflections on: ‘Pectoral I block does not improve postoperative analgesia after breast cancer surgery’

“…I read the article about Pectoral I Block (Pecs I), published in the August 2018 issue, with great interest 1. I sincerely appreciate the authors for analyzing the Pecs I block with a placebo control under the multimodal analgesic regime at dual centers very meticulously.…”

“…The total number of patients included in the study was 127. However, the flow diagram (Figure 1 of the article1) is not clear because, it depicts 59 vs 63 patients in the bupivacaine versus placebo groups respectively at the ‘per-protocol analysis’ level, following the ‘intention-to-treat’ stage. In addition, there was an exclusion of three patients in each group at the ‘per-protocol analysis’ stage (ie, 59–3=56, 63–3=60; total of 116 patients) which adds further confusion.…”