Pectoral Nerve Block and Erector Spinae Plane Block and Post-Breast Surgery Complications

Abstract

Background: The use of regional methods in various types of surgery such as mastectomy is very popular today. Various methods, including Pecs I-II block, erector spinae, epidural thoracic, and paravertebral block have been used in these operations, each with its own advantages and disadvantages. Recent studies on the effect of µ receptor stimulation on the likelihood of recurrence and metastasis have been published, which make the use of a suitable regional approach with low complications and high efficacy attractive. Among the side effects of breast surgery in patients with cancer are nausea and vomiting, the risk of which is reduced through regional procedures that reduce the need for opioids. Methods: We randomly divided 64 patients into two pectoralis block (Pecs B) and erector spinae block (ESB) groups. Visual analogue scale (VAS) scores at 2, 4, 6, and 10 hours, nausea and vomiting, need for opioids, and hemodynamic changes were recorded. Results: The analyses showed that pain score was significantly higher in the Pecs B group compared to the ESB group, while VAS score, as well as the frequency of opioid use, were lower, which could be due to medial branch of the anterior intercostal nerve. Hemodynamic changes were also significantly greater in the ESB group, which could be due to the proximity of the block to the thoracic sympathetic nerves and spinal cord. Conclusions: Despite the statistically significant differences in analgesia and hemodynamic changes, the seemingly superiority of the Pecs B is not clinically significant and the use of both types of the block is selective. Regarding the need for opioids and nausea, Pecs B showed a tangible advantage over ESB.

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).…”

“…Khorasanizadeh and colleagues showed that the Pecs II block reduced the pain score ( P =0.032) and decreased the need for opioids ( P =0.041) than the ESPB. However, Pecs II block is not clinically significant, and both types (Pecs II and ESPB) are selective 62. Song et al64 revealed that the combination of Pecs I block, SPB, and parasternal intercostal block significantly lowered the NRS pain scores through movement.…”

“…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).…”

Evaluation of ultrasound guided erector spinae plane block efficacy on post operative pain in lumbar spine surgery: a randomized clinical trial

“…[23] Although first suggestion was to perform in sitting position, it is now applied in all positions. [24] The simplicity and safety of this technique in addition to acceptable analgesia, has made it a desirable choice for pain management after various kinds of surgery as breast surgery, [8,25] thoracic surgery, [4,24] and shoulder pain, bariatric sur-…”

“…[3] Erector spinae plane block (ESPB) first described by Forero in 2016. [4] Since then, this block has been reported by several anesthesiologists for post-operative pain management after different types of surgeries such as thoracic, breast and spine surgical procedures, [5][6][7][8][9][10][11][12][13][14] as well as for chronic pain management. [15,16] Most of the literature concerning ESPB in spine surgery are case report, [10][11][12][13][14][15][17][18][19][20] and clinical trials are scars.…”