The Patient-Reported Outcome of Intra-Operative Direct Vision Pectoral Nerve Block for Postoperative Analgesia for Breast Surgery

Abstract

Background and Aims: Pectoral nerve blocks gained increasing recognition for adequate postoperative pain relief following breast surgery. Traditionally, anaesthetist administered preoperatively under ultrasound guidance, which added significantly to the total procedure time. We studied the effectiveness of intraoperative direct vision pectoral nerve block and reduction of total theatre time. Methods: We provided questionnaires to the eligible patients who underwent a mastectomy and or axillary node clearance from August 2018 to May 2019. All the patients had an intra-operative pectoral 1 and serratus plane (Pecs) block. Participants documented pain score twice daily, episodes of nausea or vomiting and type and dose of analgesia for the first seven postoperative days. We compiled and grouped the results into postoperative days 1 -2 and 3 -7 for data analysis. Results: Patients reported generally low levels of pain, with a median pain score of 1.75 out of 10 for postoperative days 1 -2 (IQR 4). The score decreased to 0.7 for days 3 -7 postoperatively (IQR 3) suggesting that most patients had generally minimal levels of pain apart from a few outliers. The average injection time for PECs blocks was 5 minutes, significantly less than USS guided techniques of 20 -30 minutes. Conclusions: Our data suggest that nerve blocks under direct vision offer satisfactory efficacy in postoperative analgesia with minimal nausea and vomiting. This is in addition to substantial benefits in operative efficiency and reduction of total procedure time.

Additional intraoperative subpectoral plane block vs conventional pain control: A comparison of shoulder movement in patients with mastectomy

“…PECs with sedation could be a viable alternative to general anesthesia for patients with severe medical comorbidities [ 21 ]. Dube et al conducted a prospective observational study and showed that intraoperative direct vision PECs could reduce the operative time significantly with good efficacy when compared to preoperative ultrasound guidance PECs [ 13 ]. However, a study by Desroches et al reported that PECs caused a significant motor blockage in the pectoralis muscles, which affected the adductor strength of the patients [ 22 ].…”

“…This technique involved injection of 10 ml of local anesthetic into the plane between the pectoris major and minor muscles to block the medial and lateral pectoral nerves. An additional injection of 10 ml of local anesthetic was administered in the plane between the pectoralis minor and serratus anterior muscles to block the lateral cutaneous nerve, long thoracic nerve, and thoracodorsal nerve [ 13 ]. Nevertheless, participants in the control group were not administered with the placebo and all patients had not been performed breast reconstruction after surgery.…”