Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: A randomized controlled trial

ELdeen, Hala M.S.

doi:10.1016/j.egja.2015.08.005

Cited by 35 publications

(28 citation statements)

References 19 publications

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“…Four Pecs II block studies with a median Jadad score of 3 were included in our review [105][106][107][108] (Table 4). Bashandy and Abbas 106 investigated Pecs II block versus no block for modified radical mastectomy in an observer-blinded study.…”

Section: Interfascial Plane Blocksmentioning

confidence: 99%

Perioperative Breast Analgesia

Woodworth

Ivie

Nelson

et al. 2017

Regional Anesthesia and Pain Medicine

265

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Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analgesic techniques for managing perioperative pain. We performed a systematic review of the evidence for these analgesic techniques, including intercostal block, epidural administration, paravertebral block, brachial plexus block, and novel peripheral nerve blocks.

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Section: Interfascial Plane Blocksmentioning

confidence: 99%

Perioperative Breast Analgesia

Woodworth

Ivie

Nelson

et al. 2017

Regional Anesthesia and Pain Medicine

265

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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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“…Finally, we are aware of a paper from Ali Hassn et al 6 and should have explained why we did not include it in our paper. We believe, as others, 3 that there is still a need to evaluate both PECS I and II blocks as described by Dr. Blanco. 7 In the Ali Hassn et al study, they used a PECS II block with a mixture of bupivacaine and dexmedetomidine 1 lgÁkg -1 .…”

Section: To the Editormentioning

confidence: 69%

“…Dr. M S mentions the study of Dr. ELdeen, 3 which raises many issues. Firstly, those authors studied patients with breast lumps scheduled for conservative breast surgery without axillary clearance.…”

Section: To the Editormentioning

confidence: 99%

In reply: Clarification on: “Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes”

Desroches

Roy

Beaulieu

2018

Can J Anesth/J Can Anesth

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clinical practice, we strongly believe that basic knowledge of their sensory and motor blocking capacity, and ultimately clinical efficacy, is lacking.Dr. M S mentions the study of Dr. ELdeen, 3 which raises many issues. Firstly, those authors studied patients with breast lumps scheduled for conservative breast surgery without axillary clearance. This less invasive breast surgery, which does not involve the pectoral muscles, does not require an interpectoral injection component. 4 The possibility of performing this type of surgery under a PECS II block is anatomically reasonable if the tumor is not located too medially. Contrary to the statement in their discussion, the PECS II does not block the T2-T6 spinal nerves, and thus only their lateral cutaneous branches, and would therefore not be adequate for surgery on the anterior medial chest wall. Contrary to Dr. M S's statement, this area is not innervated by the pectoral nerves. The description of sensory testing in the methods section of Dr. ELdeen's study lacks a clear mention of where it was tested on the chest wall. We believe that they could not have obtained a sensory block in the parasternal area.The study by Hetta and Rezk 5 showed the superiority of the paravertebral block (PVB) over the pectoralis-serratus plane block (basically the PECS II without the interpectoral injection) for radical mastectomy. We believe, contrary to Dr. M S, that the superiority of the PVB comes, in part, from its ability to also block the anterior cutaneous branches of the intercostal nerves, which is not the case with the PECS II block. Radical mastectomy involves the pectoral muscles, thus interpectoral injection of the PECS II could theoretically be of benefit. Nevertheless, our own experience with these blocks (currently un-published data) indicates that a PECS I block is not beneficial for surgery involving the pectoral muscles.Finally, we are aware of a paper from Ali Hassn et al. 6 and should have explained why we did not include it in our paper. We believe, as others, 3 that there is still a need to evaluate both PECS I and II blocks as described by Dr. Blanco. 7 In the Ali Hassn et al. study, they used a PECS II block with a mixture of bupivacaine and dexmedetomidine 1 lgÁkg -1 . The addition of dexmedetomidine to local anesthetic could have contributed, at least in part, to the efficacy of the PECS II block compared with placebo. They observed a significant reduction in intubation heart rate and blood pressure in the bupivacaine-dexmedetomidine group that they attributed to dexmedetomidine. In conclusion, we believe that more studies are needed to help determine the best clinical use of the PEC blocks.

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Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: A randomized controlled trial

Cited by 35 publications

References 19 publications

Perioperative Breast Analgesia

Perioperative Breast Analgesia

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

In reply: Clarification on: “Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes”

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