Pectoral Nerves Blocks for Chronic Pain (PNBCP)
Pectoral Nerves Blocks and Their Effect on Chronic Pain After Breast Cancer Surgery
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
One hundred and forty adult female participants scheduled for elective unilateral modified radical mastectomy under general anesthesia are randomly allocated to receive either general anesthesia plus Pecs block(Pecs group, n=70) or general anesthesia alone (control group, n=70).
After arrived in the operating room,the participants in the control group are accepted the general anesthesia.Whereas,after anesthesia induction,the participants in the Pecs group receive an ultrasound-guided Pecs block and a 15 minute observation time prior before the start of the operation.
Pecs block technology: A broadband (5-12 hertz) linear array probe of Sonosite Edge portable ultrasound system (Sonosite Inc,Bethel,Washington) is used, with an imaging depth of 4 to 6 cm. After cleaning the infraclavicular and axillary regions with chlorhexidine, the probe is placed below the lateral third of the clavicle, similar to what is done when performing infraclavicular brachial plexus block. After recognition of the appropriate anatomical structures, the skin puncture point is infiltrated with 2% lignocaine, then the block is performed by using a 20-gauge Tuohy needle. The needle is advanced to the tissue plane between the pectoralis major and pectoralis minor muscle at the vicinity of the pectoral branch of the acromiothoracic artery, and 10 mL of 0.35% ropivacaine deposited. In a similar manner, 20 mL is deposited at the level of the third rib below the serratus anterior muscle with the intent of spreading injectate to the axilla.
Study Type
Study Type
Enrollment (Anticipated)
Enrollment
Phase
Phase
- Early Phase 1
Contacts and Locations
Study Contact
Study Contact
- Name: Tan Jing, M.D;PhD
- Phone Number: 0086-18302982890
- Email: 18991232757@189.cn
Study Locations
-
-
Shaanxi
-
Xi'an, Shaanxi, China, 710061
- Recruiting
- First Affiliated Hosipital of Xi'an Jiaotong Univercity
-
Contact:
- Tan Jing, M.D;PhD
- Phone Number: 0086-18302982890
- Email: 18991232757@189.cn
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Modified radical mastectomy
- American Society of Anesthesiologists physical status 1-3
- BMI 18-35 kg/m2
Exclusion Criteria:
- Declining to give written informed consent;
- Uncontrolled hypertension;
- Allergy to local anesthetics;
- Pregnancy;
- Alcohol or drug abuse;
- Prior breast surgery except for diagnostic biopsies;
- Contraindication to the use of regional anesthesia;
- History of chronic pain or psychiatric disorder and pregnant patients;
- Consumption of NSAID, cyclooxygenase-2 inhibitors or paracetamol within 24 hours before the investigation;
- Infection at the needle site.
- Inability to properly describe postoperative pain to investigators (eg, language barrier, neuropsychiatric disorder)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Ropivacaine
Ropivacaine hydrochloride injection; Generic name:Naropin; Dosage form:Liquid、Injectable formulation; Dosage:105mg;30ml; Frequency:Once.
|
Local injection of local anesthetic into the fascial spaces
Other Names:
|
|
Placebo Comparator: Normal saline
Medical Normal saline Generic name:Normal saline; Dosage form:Liquid、Injectable formulation; Dosage:30ml; Frequency:Once.
|
Sodium chloride solution commonly used in clinical which equal to human plasma osmotic pressure.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
The incidence of chronic postoperative pain for 3 months after modified radical mastectomy surgery
Time Frame: 3 months after modified radical mastectomy surgery
|
An anesthesiologist interviews the patients by phone to determine the postoperative pain at 3 months after surgery.
Chronic pain is defined as pain in the surgical area or the ipsilateral arm, present at least 4 days a week, with an intensity of 3 or more on the verbal rating scale(0=no pain to 10=worst imaginable pain),described as a typical neuropathic pain consisting of burning pain, shooting pain, pain evoked by pressure, and deep blunt pain.
|
3 months after modified radical mastectomy surgery
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Postoperative Numerical Rating scale (NRS) score for pain
Time Frame: 0 hour postoperative
|
Pain scores(0-10)during rest and cough based on measurement at 0 hour postoperative.
|
0 hour postoperative
|
|
Postoperative Numerical Rating scale (NRS) score for pain
Time Frame: 4 hours postoperative
|
Pain scores(0-10)during rest and cough based on measurement at 4 hours postoperative.
|
4 hours postoperative
|
|
Postoperative Numerical Rating scale (NRS) score for pain
Time Frame: 12 hours postoperative
|
Pain scores(0-10)during rest and cough based on measurement at 12 hours postoperative.
|
12 hours postoperative
|
|
Postoperative Numerical Rating scale (NRS) score for pain
Time Frame: 24 hours postoperative
|
Pain scores(0-10)during rest and cough based on measurement at 24 hours postoperative.
|
24 hours postoperative
|
|
Postoperative Numerical Rating scale (NRS) score for pain
Time Frame: 48 hours postoperative
|
Pain scores(0-10)during rest and cough based on measurement at 48 hours postoperative.
|
48 hours postoperative
|
|
Postoperative Numerical Rating scale (NRS) score for pain
Time Frame: 72 hours postoperative
|
Pain scores(0-10)during rest and cough based on measurement at 72 hours postoperative.
|
72 hours postoperative
|
Collaborators and Investigators
Sponsor
Sponsor
Publications and helpful links
General Publications
- Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009 Nov 11;302(18):1985-92. doi: 10.1001/jama.2009.1568. Erratum In: JAMA. 2012 Nov 21;308(19):1973.
- Amaya F, Hosokawa T, Okamoto A, Matsuda M, Yamaguchi Y, Yamakita S, Taguchi T, Sawa T. Can acute pain treatment reduce postsurgical comorbidity after breast cancer surgery? A literature review. Biomed Res Int. 2015;2015:641508. doi: 10.1155/2015/641508. Epub 2015 Oct 1.
- Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5. doi: 10.1016/j.redar.2012.07.003. Epub 2012 Aug 29.
- Bashandy GM, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med. 2015 Jan-Feb;40(1):68-74. doi: 10.1097/AAP.0000000000000163.
- Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AM, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender R; American Cancer Society. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015 Oct 20;314(15):1599-614. doi: 10.1001/jama.2015.12783. Erratum In: JAMA. 2016 Apr 5;315(13):1406.
- Bolin ED, Harvey NR, Wilson SH. Regional anesthesia for breast surgery: Techniques and benefits. Current Anesthesiology Reports 2015;5:217-224.
- Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006 Sep;7(9):626-34. doi: 10.1016/j.jpain.2006.02.007.
- Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain. 2003 Jul;104(1-2):1-13. doi: 10.1016/s0304-3959(03)00241-0. No abstract available.
- Blanco R. The 'pecs block': a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011 Sep;66(9):847-8. doi: 10.1111/j.1365-2044.2011.06838.x. No abstract available.
- Perez MF, Miguel JG, de la Torre PA. A new approach to pectoralis block. Anaesthesia. 2013 Apr;68(4):430. doi: 10.1111/anae.12186. No abstract available.
- Perez MF, Duany O, de la Torre PA. Redefining PECS Blocks for Postmastectomy Analgesia. Reg Anesth Pain Med. 2015 Nov-Dec;40(6):729-30. doi: 10.1097/AAP.0000000000000243. No abstract available.
- Ibarra MM, S-Carralero GC, Vicente GU, Cuartero del Pozo A, Lopez Rincon R, Fajardo del Castillo MJ. [Chronic postoperative pain after general anesthesia with or without a single-dose preincisional paravertebral nerve block in radical breast cancer surgery]. Rev Esp Anestesiol Reanim. 2011 May;58(5):290-4. doi: 10.1016/s0034-9356(11)70064-0. Spanish.
- Karmakar MK, Samy W, Li JW, Lee A, Chan WC, Chen PP, Ho AM. Thoracic paravertebral block and its effects on chronic pain and health-related quality of life after modified radical mastectomy. Reg Anesth Pain Med. 2014 Jul-Aug;39(4):289-98. doi: 10.1097/AAP.0000000000000113.
- Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer. 2008 Aug 19;99(4):604-10. doi: 10.1038/sj.bjc.6604534.
Study record dates
Study Major Dates
Study Start
Study Start
Primary Completion (Anticipated)
Primary Completion
Study Completion (Anticipated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimate)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- XJTU1AF-CRS-2016-003
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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