Pectoral Nerve Blocks for Breast Augmentation Surgery: A Randomized, Double-blind, Dual-centered Controlled Trial

Abstract

Background Pectoral nerve blocks have been proposed for analgesia during and after breast cancer surgery, but data are conflicted in aesthetic breast surgery. This trial tested the primary hypothesis that adding a preincisional pectoral nerve block is superior to systemic multimodal analgesic regimen alone for pain control after breast augmentation surgery. A second hypothesis is that rescue opioid consumption would be decreased with a long-lasting effect for both outcomes during the following days. Methods Seventy-three adult female patients undergoing aesthetic breast augmentation surgery under general anesthesia were randomly allocated to receive a pectoral nerve block versus no block. Both groups received standard care with protocolized multimodal analgesia alone including systematic acetaminophen and nonsteroidal anti-inflammatory drugs. The primary outcome measure was the maximal numerical rating scale in the first 6 h after extubation. Secondary outcomes included intraoperative remifentanil consumption and from extubation to day 5: maximal numerical rating scale, postoperative cumulative opioid consumption and postoperative opioid side effects, and patient satisfaction recorded at day 5. Results The maximal numerical rating scale score in the first 6 h was lower in the pectoral nerve block group compared with the control group (3.9 ± 2.5 vs. 5.2 ± 2.2; difference: –1.2 [95% CI, –2.3 to –0.1]; P = 0.036). The pectoral nerve block group had a lower maximal numerical rating scale between days 1 and 5 (2.2 ± 1.9 vs. 3.2 ± 1.7; P = 0.032). The cumulative amount of overall opioids consumption (oral morphine equivalent) was lower for the pectoral nerve block group from hour 6 to day 1 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 31.5] mg, P = 0.006) and from days 1 to 5 (0.0 [0.0 to 21.0] vs. 21.0 [0.0 to 51] mg, P = 0.002). Conclusions Pectoral nerve block in conjunction with multimodal analgesia provides effective perioperative pain relief after aesthetic breast surgery and is associated with reduced opioid consumption over the first 5 postoperative days. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Reduced postoperative pain in patients receiving nociception monitor guided analgesia during elective major abdominal surgery: a randomized, controlled trial

“…When corrected for the predominance of female subjects in the NOL guided cohort, the differences in pain scores were more pronounced at 1.5 at 90 min respectively. Although we did not show a reduction of 2 points on the NRS scale as hypothesized, the results do meet currently accepted definitions for clinical meaningfulness as demonstrated in recent studies that were powered for an improvement of 1.3 points or an improvement of 30% [ 13 ] [ 14 ].…”

Assessing Postoperative Benefits of a Nerve Block: Study Design is Critical [Letter]

“…However, the readers were not provided absolute decrease in 24-h intravenous milligram morphine consumption in the TPVB group compared with the control group, as performed in a previous study. 5 Thus, it was unclear whether absolute decrease in 24-h intravenous milligram morphine consumption in the TPVB group exceeded the recommended minimal clinically important difference in the literature, ie, an absolute reduction of 10 mg intravenous morphine. 6 …”

Pectoral Nerve Blocks for Breast Augmentation Surgery: Comment

“…Similarly, in the Discussion, while referring to Hussain et al . 5 again, Aarab et al 1 mistakenly cited the quote as coming from reference 18 instead of from reference 16. In addition, in the Results, reference 31 was quoted for French law regarding exclusion criteria.…”

“…I read the recently published article on pectoral nerve blocks (PECS) for breast augmentation procedures with immense interest. 1 I greatly appreciate the authors for analyzing the efficacy of PECS blocks on breast augmentation procedures and congratulate them for publishing this wonderful study on this topic that has only a few studies in the literature. I wish to present my reflections on it.…”

“…Aarab et al . 1 mentioned that theirs is the first study to provide PECS blocks after general anesthesia but before surgery, thereby facilitating sensory block during surgery itself. However, to my knowledge, there are few more studies that have provided PECS blocks before the commencement of surgical procedure (breast augmentation).…”