Prospective Double Blind Randomized Placebo-Controlled Clinical Trial of the Pectoral Nerves (Pecs) Block Type II

Versyck, Barbara; Geffen, Geert‐Jan van; Houwe, Patrick Van

doi:10.1097/sa.0000000000000338

Cited by 73 publications

(34 citation statements)

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“…Intra‐operative opioid requirements were found to be significantly lower after a PECS‐2 block compared with no block . Lower pain scores and a reduction in postoperative opioid consumption have been reported in patients having PECS‐2 blocks compared with no block or placebo .…”

Section: Resultsmentioning

confidence: 89%

“…The pectoral nerves (PECS)‐1 block is performed by injecting local anaesthesia between the pectoralis major and minor muscles, whereas the PECS‐2 block includes the PECS‐1 interpectoral injection along with infiltration of local anaesthesia between the pectoralis minor and the serratus anterior muscles. Twelve studies have investigated the analgesic effects of intra‐operative PECS blocks in minor and major breast surgery . Intra‐operative opioid requirements were found to be significantly lower after a PECS‐2 block compared with no block .…”

Section: Resultsmentioning

confidence: 99%

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PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Summary Analgesic protocols used to treat pain after breast surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological breast surgery. A systematic review using preferred reporting items for systematic reviews and meta‐analysis guidance with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty‐nine studies were found, of which 53 randomised controlled trials and nine meta‐analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra‐operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non‐steroidal anti‐inflammatory drugs) administered pre‐operatively or intra‐operatively and continued postoperatively. In addition, pre‐operative gabapentin and dexamethasone are also recommended. In major breast surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…According to Blanco et al () the Pecs II technique consists of the lateral Pecs I anesthetic blockade with the deep Pecs II injection to block at least the pectoral nerves, the intercostobrachial nerve, the lateral cutaneous part of the III–VI intercostal nerves and the long thoracic nerve. Given the more extensive spread of the Pecs II anesthetic blockade to the nerves of interest for many common types of chest wall surgery and the favorable results (Bashandy and Abbas, ; Kulhari et al, ; Versyck et al, ), the individual contribution of Pecs I anesthetic blockade faded to the background. However, in a letter to the editor, Pérez et al () mentioned that local anesthetic injected between the pectoral muscles achieves spreading between the clavipectoral fascia and the deep layer of the pectoral fascia toward the axilla because the major and minor pectoral muscles are part of the anterior axillary wall, thus effectively blocking the axilla.…”

Section: Discussionmentioning

confidence: 99%

“…The block is performed similar as the lateral approach of the Pecs I block and the needle is further advanced to perform the deep injection between the Pmi and SA. The Pecs anesthetic blockades have become common techniques in clinical practice and the Pecs II block has been subject to multiple trials evaluating its clinical impact (Bashandy and Abbas, ; Kulhari et al, ; Versyck et al, ).…”

Section: Introductionmentioning

confidence: 99%

The pecs anesthetic blockade: A correlation between magnetic resonance imaging, ultrasound imaging, reconstructed cross‐sectional anatomy and cross‐sectional histology

et al. 2019

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The interfascial thoracic wall blockades Pecs I and Pecs II are increasingly applied in breast and axillary surgery. Despite the clear anatomical demarcations depicted at their introduction, the clinical outcome is more variable than would be expected based upon the described anatomy. In order to elucidate factors that explain this variability, we evaluated the spread of each injectionmedial Pecs I, lateral Pecs I, the deep injection of the Pecs II-separately. A correlation of in vivo landmarks and ultrasound images with ex vivo ultrasound, reconstructed anatomical planes, histology and magnetic resonance imaging. The medial Pecs I, similar to the sagittal infraclavicular block positioning with needle position medial to the pectoral branch of the thoracoacromial artery, reaches the medial and lateral pectoral nerves. The lateral Pecs I, below the lateral third of the clavicle at the level of the third rib with needle position lateral to the pectoral branch of the thoracoacromial artery, additionally spreads to the axilla and reaches the intercostobrachial nerve. The deep Pecs II injection spreads to the lateral cutaneous part of the III-VI intercostal nerves and reaches the long thoracic nerve. The variability of the Pecs anesthetic blockades is driven by the selected Pecs I approach as only the lateral approach stains the intercostobrachial nerve. The pectoral branch of the thoracoacromial artery can serve as the landmark to differentiate the needle position of the medial and lateral Pecs I block. Clin. Anat. 32:421-429, 2019.

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“…Résultats La force moyenne de l'adducteur (écart-type [ET]) évaluée avant le bloc était de 119,4 (20,7) Newtons (N). Après le bloc PECS I avec la bupivacaïne, la force moyenne (ET) était de 54,2 (16,3) N comparée à 116,0 (30,4) N dans le groupe placebo (différence des moyennes 61,8 N; intervalle de confiance à 95% [IC] : 27,8 à 95,8; P = 0,005), démontrant une baisse de 54,6% (IC à 95% : 43,6 à 65,6%) de la force d'adduction. Il n'y a pas eu de différence pour les tests de sensibilité des dermatomes cutanés entre les cô tés ayant reçu le placebo ou la bupivacaïne.…”

Section: Résuméunclassified

Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes: a prospective volunteer randomized-controlled double-blind study

Desroches

Belliveau

Bilodeau

et al. 2018

Can J Anesth/J Can Anesth

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Prospective Double Blind Randomized Placebo-Controlled Clinical Trial of the Pectoral Nerves (Pecs) Block Type II

Cited by 73 publications

References 0 publications

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

The pecs anesthetic blockade: A correlation between magnetic resonance imaging, ultrasound imaging, reconstructed cross‐sectional anatomy and cross‐sectional histology

Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes: a prospective volunteer randomized-controlled double-blind study

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