- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04284098
PECS Block With Bupivacaine Vs Bupivacaine and Dexmedetomidine in Modified Radical Mastectomy
Ultrasound Guided Pectoral Nerve Block Using Bupivacaine Versus Bupivacaine and Dexmedetomidine as a Supplement to General Anesthesia in Modified Radical Mastectomy
The incidence of breast cancer as well as the need for surgical treatment has increased.
Breast cancer surgery (BCS) is associated with many complications such as increased incidence of acute and chronic postoperative pain, postoperative nausea and vomiting (PONV), delayed hospital discharge.
Acute postoperative pain is an integral risk factor in the development of chronic pain after BCS.
Inadequate pain control can impact patient recovery including impaired pulmonary and immune function with an increased risk of ileus, thromboembolism, and myocardial infarction.
General anesthesia (GA) is the technique that commonly used for breast surgeries. The downside of GA includes inadequate pain control with high incidence of PONV . Also postoperative opioid for postoperative pain usually associated with many complications Regional anesthesia for breast surgery holds a great promise for breast cancer patients in terms of improved acute pain control with chronic pain prevention. It offers adequate analgesia while minimizing opioid consumption.
This study was designed in order to assess the efficacy and safety of PECS block as a supplement to GA in modified radical mastectomy (MRM) . Also to assess its role in decreasing the amount of opioid in the intra- and postoperative period after MRM. Also to assess its role in decreasing postoperative complications after BCS such as postoperative nausea and vomiting, delayed hospital discharge,and acute postoperative pain. Also to assess the role of dexmedetomidine in prolongation of the analgesic effect of PECS block.
Study Overview
Status
Conditions
Detailed Description
Breast cancer is the most frequent cancer among women; it causes the highest number of cancer-related deaths among them globally. The prognosis has improved considerably over the past 30 years, and the 5-year survival rate of patients has been increased due to the advances in the early detection and treatment of breast cancer.
Breast cancer surgery is associated with many complications such as increased incidence of acute and chronic postoperative pain, postoperative nausea and vomiting, delayed hospital discharge, and cancer recurrence. One of the most important complications is the occurrence of acute postoperative pain. Acute postoperative pain is an integral risk factor in the development of chronic pain after breast cancer surgery (BCS).
Inadequate pain control can impact patient recovery including impaired pulmonary and immune function with an increased risk of ileus, thromboembolism, and myocardial infarction. These factors can further increase the hospital length of stay, increase the healthcare costs, and decrease the patient satisfaction.
General anesthesia, including intravenous and inhalational agents, is the technique that commonly used for breast surgeries. The drawbacks of general anesthesia include inadequate pain control with high incidence of nausea and vomiting. Also the use of opioid and non-opioid analgesics for postoperative pain usually associated with many complications.
Regional anesthesia for breast surgery holds a great promise for breast cancer patients in terms of improved acute pain control with chronic pain prevention. It offers adequate analgesia while minimizing opioid consumption and its related side effects.
Several techniques of blocks for breast surgery have been described. Thoracic epidural and paravertebral blocks were the gold standard techniques to achieve this goal. However, these techniques are generally performed before general anesthesia, and not all anesthesiologists feel comfortable using such invasive procedures in BCS. AS an alternative for these techniques, pectoral nerves (PECS) block has been reported as a promising technique during BCS.
PECS block is an interfascial peripheral nerve block described since 2011.The original block is PECS I block, in which local anesthetic is deposited between the pectoralis major and pectoralis minor muscles to block the lateral pectoral nerve (C5, 6, 7) and medial pectoral nerve (C8, T1) providing analgesia to the anterior chest wall.
PECS II block is a modified PECS I. In this block, local anesthetic is injected between the serratus anterior and pectoralis minor muscle at the third rib in addition to the original block aimed to block thoracic intercostal nerves (T2-6) including intercostobrachial nerve and long thoracic nerve (C5-C7). This modification aimed to extend analgesia to the axilla; this is needed for axillary clearance, necessary for wide excisions, tumorectomy, lymph node excision and several types of mastectomies.
It differs from thoracic epidural and paravertebral blocks as there is no associated sympathetic block. It can be performed while the patient in the supine position and it can be done before or after induction of general anesthesia.
The use of ultrasound (US) makes the pectoral nerve block more accurate and less injurious to nearby structures such as the parietal pleura. It helps direct visualization of anatomical structures, it finds the possible variations in the origin, course, the accompanying structures of the medial and lateral pectoral nerves and their relation to the important structures such thoracoacromial artery and parietal pleura to avoid their injury during performing the PECS block.
The addition of dexmedetomidine to bupivacaine can improve the quality of the block, significantly prolong the duration of analgesia, and provides better pain control postoperatively without major side effects.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Thorya M Salem, MSc
- Phone Number: +201006995112
- Email: dr_2010@yahoo.com
Study Locations
-
-
-
Zagazig, Egypt
- Thorya M Salem
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Hospitalized for modified radical mastectomy. American Society of Anesthesiologists (ASA), physical status II. Age between 21-65 year.
Exclusion Criteria:
Patient's refusal. Preexisting coagulopathy or anti-coagulant therapy. Local infection at site of injection. Pregnancy or breast feeding. Body Mass Index (BMI) > 35kg/m². Allergy to local anesthetics and drugs used. Prior breast surgery except for diagnostic biopsies.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: GA group
Group I (GA group): Standard general anesthesia (GA) .
|
Patients received standard GA including fentanyl as intraoperative analgesic and morphine as postoperative analgesic in the first 24 hours.
|
Active Comparator: Bupivacaine group
Group II (B group): ultrasound-guided PECS block using bupivacaine 0.25% + standard GA.
|
The patients undergo an ultrasound-guided PECS I using 10 ml bupivacaine 0.25% and PECS II using 20 ml bupivacaine 0.25%, after 10-minutes observation the patients receive standard GA including fentanyl as intraoperative analgesic and morphine as postoperative analgesic in the first 24 hours.
|
Active Comparator: Dexmedetomidine&bupivacaine group
Group III (D group): ultrasound-guided PECS block using bupivacaine 0.25% and Dexmedetomidine 1µg/kg+standard GA.
|
D group:The patients undergo an ultrasound-guided PECS I using 10 ml bupivacaine 0.25% and PECS II using 20 ml bupivacaine 0.25%+dexmedetomidine (1µg/kg) after 10-minutes observation the patients receive standard GA including fentanyl as intraoperative analgesic and morphine as postoperative analgesic in the first 24 hours.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Total intraoperative opioid consumption.
Time Frame: During operation.
|
Total intraoperative fentanyl.
|
During operation.
|
Total postoperative opioid consumption.
Time Frame: First 24 hours after surgery.
|
Total postoperative morphine consumption.
|
First 24 hours after surgery.
|
First time to rescue analgesia.
Time Frame: First 24 hours after surgery.
|
Duration of postoperative analgesia.
|
First 24 hours after surgery.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Postoperative pain score.
Time Frame: 0.3,6,9,12, and 24 hours after surgery.
|
Visual analogue scale (VAS) which is a unidimensional measure of pain intensity, it is a 10 cm line ranging from (0=no pain to 10 = worst pain imaginable) .
The patient is asked to mark on this line where the intensity of the pain lies.
|
0.3,6,9,12, and 24 hours after surgery.
|
Postoperative nausea &vomiting
Time Frame: First 24 hours after surgery.
|
postoperative nausea &vomiting (yes or no)
|
First 24 hours after surgery.
|
Hospital length of stay.
Time Frame: First 3 days after surgery.
|
days until the patients are discharged to home.
|
First 3 days after surgery.
|
Patients and surgeon satisfaction
Time Frame: First 24 hours after surgery.
|
Surgeon satisfaction is assessed by Surgeon Satisfaction with Anesthesia Services (SSAS) the scale was composed of four levels (Strongly disagree, Disagree, Agree, strongly agree) ,Patient satisfaction (yes or no).
|
First 24 hours after surgery.
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Doaa M Farid, MD, Faculty of medicine,Zagazig University,Egypt
- Study Chair: Maha I El desouky, MD, Faculty of medicine,Zagazig University,Egypt
- Study Director: Fatma M Ahmed, MD, Faculty of medicine,Zagazig University,Egypt
Publications and helpful links
General Publications
- Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth. 2016 Sep;117(3):382-6. doi: 10.1093/bja/aew223.
- Battista C, Krishnan S. Pectoralis Nerve Block. 2022 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK547691/
- Besch G, Lagrave-Safranez C, Ecarnot F, De Larminat V, Gay C, Berthier F, Samain E, Pili-Floury S. Pectoral nerve block and persistent pain following breast cancer surgery: an observational cohort study. Minerva Anestesiol. 2018 Jun;84(6):769-771. doi: 10.23736/S0375-9393.18.12544-2. Epub 2018 Feb 15. No abstract available.
- Campos M, Azevedo J, Mendes L, Rebelo H. Pectoral nerve block as a single anesthetic technique for breast surgery and sentinel lymph node investigation. Rev Esp Anestesiol Reanim (Engl Ed). 2018 Nov;65(9):534-536. doi: 10.1016/j.redar.2018.05.005. Epub 2018 Jul 21. English, Spanish.
- Turbitt L, Nelligan K, McCartney C. Pectoral Nerve Blocks for Breast Cancer Surgery: A Methodological Evaluation. Reg Anesth Pain Med. 2015 Jul-Aug;40(4):388-9. doi: 10.1097/AAP.0000000000000226. No abstract available.
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Hypnotics and Sedatives
- Anesthetics, Local
- Dexmedetomidine
- Bupivacaine
Other Study ID Numbers
- PECS in Breast Cancer Surgery
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Anesthesia
-
Samsun UniversityCompletedAnesthesia | Regional Anesthesia | Anesthesia ManagementTurkey
-
Charite University, Berlin, GermanyCompletedAnesthesia, Local | Anesthesia | Anesthesia; Adverse EffectGermany
-
Novocol Pharmaceutical of Canada, Inc.CompletedAnesthesia, Local | Dental Anesthesia | Anesthesia, ReversalUnited States
-
Aligarh Muslim UniversityCompletedAnesthesia | Anesthesia Intubation Complication | Anesthesia; Adverse EffectIndia
-
Universitas Sebelas MaretIndonesia Endowment Fund for EducationNot yet recruitingAnesthesia | Anesthesia; Reaction
-
University of PecsCompleted
-
Hormozgan University of Medical SciencesUnknownAnesthesia | Anesthesia; FunctionalIran, Islamic Republic of
-
University of ChicagoRecruitingAnesthesia | Patient Satisfaction | Anesthesia Risks | Anesthesia Consent | Consent RetentionUnited States
-
Assistance Publique - Hôpitaux de ParisINSERM UMR-942, Paris, France; M3DISIMNot yet recruitingPrediction Models for Cardiovascular and Neurocognitive Disease Risk in the General Population (CME)Anesthesia, Local | AnesthesiaFrance
-
Matthew BorzageRecruitingAnesthesia | Anesthesia; ReactionUnited States
Clinical Trials on General anesthesia (GA).
-
Augusta UniversityUniversity of Michigan; Henry Ford Health SystemCompleted
-
Sedat ÖnenBursa City HospitalCompleted
-
Ondokuz Mayıs UniversityCompleted
-
Fudan UniversityWashington University School of MedicineUnknown
-
Fudan UniversityWashington University School of MedicineUnknown
-
University Hospital, CaenUnknownChronic Subdural HematomaFrance
-
Ottawa Hospital Research InstituteCompletedPostoperative Complications
-
Mingkwan Wongyingsinn, MDCompletedInflammation | Hernia | Anesthetics Adverse ReactionThailand
-
Mackay Memorial HospitalNational Science Council, TaiwanUnknown
-
Hospital for Special Surgery, New YorkEnrolling by invitationLumbar Disc Herniation | Lumbar Radiculopathy | Lumbar Disc DiseaseUnited States