Pectoral Nerve Block Versus Thoracic Paravertebral Block– Comparison of Analgesic Efficacy for Postoperative Pain Relief in Modified Radical Mastectomy Surgeries

Abstract

BACKGROUNDModified Radical Mastectomy (MRM) is the most common surgical procedure for operable breast malignancies. Postoperative pain has been severe in MRM cases and demands for pain relief are high. The technique of performing pectoral nerve block [PECS] using ultrasound guidance is increasing in popularity. We compared the postoperative analgesic profile of ultrasound-guided serratus plane block (SPB) and landmark-guided paravertebral block (PVB). MATERIALS AND METHODSThis study was done as a double blind, randomised, controlled trial among 60 subjects with breast cancer posted for elective MRM, of which 30 subjects were put in PECS block group and 30 subjects in paravertebral block group. PVB was performed under complete aseptic precaution with low resistance technique. PECS block was performed in supine position with the U/S probe directly above 1 st rib where pectoralis major and pectoralis minor muscles are located. Anaesthesia was maintained with sevoflurane 1% and O2/N20 mixture with a fraction of 50% inspired O2. Postoperative pain was recorded using the Visual Analogue Scale (VAS) every one-hour up to 4 hours post-surgery. RESULTSThe mean VAS scores were significantly lesser in the PECS group compared to the PVB group (p<0.05). The mean heart rates in PECS group were significantly lower than PVB group throughout the procedure. There was no significant difference in the intra-OP MAP between both the groups. CONCLUSIONUltrasound-guided PECS block is an alternative analgesic technique to thoracic PVB for postop pain relief in MRM patients. It gives superior analgesia and has fewer complications. BACKGROUND Breast cancer has emerged as the most common cancer in India, and 2 nd most common even in the rural area. Breast cancer accounts for 25% to 32% of all female cancers in all these cities. This implies, practically, one fourth of all female cancer cases are breast cancers. [1] Of the several therapeutic options for breast cancer, Modified Radical Mastectomy (MRM) is the most common surgical procedure for operable breast malignancies. Postoperative pain has been severe in MRM cases and demands for pain relief are high. KEYWORDS

A randomised controlled study of the post-operative analgesic efficacy of ultrasound-guided pectoral nerve block in the first 24 h after modified radical mastectomy

“…In this study, there was no significant difference in intra- and post-operative haemodynamic parameters between the two groups [Figures 2 and 3 ], which is supported by a similar study where pectoral nerve block and thoracic paravertebral block were compared for mastectomy. [ 17 ] In this study, better haemodynamic stability was observed intraoperatively in Group II. Thus, it can be said that Pecs block has no untoward effect on HR, SBP, DBP and MAP of the patients.…”

Efficacy of Pectoral Nerve Block Type Ii Versus Thoracic Paravertebral Block for Analgesia in Breast Cancer Surgery

“…In only one study of Syal et al, which compared fentanyl analgesia in the postoperative period, there was a greater need of opioids in Pecs group, but without statistical significance [8]. The time to first rescue analgesia was longer in the Pecs group and the same results were also observed in other similar studies [7,12,11,13]. In previous studies the time after surgery to the first rescue analgesia varied due to the different plans of postoperative analgesia according to the study design.…”

“…In the study we compared the analgesic effects of two thoracic wall nerve blocks, as TPVB is well-researched and effective method and Pecs block may be no less effective, but currently has a smaller evidence base. In this study the paravertebral block was performed at only one Th 3-4 level, as well as in most previous researches, which compared the efficacy of these two techniques [7,11,12,13]. Although there is evidence that analgesic effect is better when the paravertebral block is performed at several levels [14].…”

Efficacy of the pectoral nerve block type II and paravertebral block for enhanced recovery after breast cancer surgery

“…[27]. Подібні результати при порівнянні застосування цих двох блокад для знеболювання мастектомії у 60 пацієнток отримав G. Annamalai та співавт., де частота ПОНБ становила в групі ПБ 16,7 %, а в групі ПВБ -30 % [28]. Хоча в рандомізованому проспективному дослідженні S.S. Wahba та співавт., де були включені пацієнти після мастектомії, не виявили статистично вірогідної різниці в частоті ПОНБ між ПБ і ПВБ [9].…”

“…Дане дослідження має низку обмежень. У дослідженні виконували паравертебральний блок лише на одному рівні Тh3-4, як і в більшості попередніх робіт, де порівнювали ефективність цих двох технік [9,19,27,28]. Хоча знеболювальний ефект кращий, якщо паравертебральну блокаду виконувати на декількох рівнях [29].…”