Pectoral nerve block combined with general anesthesia for breast cancer surgery: a retrospective comparison

Abstract

Background: Acute postoperative pain is an integral risk factor in the development of chronic pain after breast cancer surgery (BCS). Pectoral nerve block (PECSB) has been recently reported as an analgesic method for BCS. Here, we retrospectively compared intraoperative opioid requirement, postoperative pain after BCS, and incidence of postoperative nausea and vomiting (PONV) in patients who underwent BCS under total intravenous anesthesia (TIVA) with or without PECSB.

Findings: We reviewed anesthesia charts and medical records of 146 patients who underwent BCS at Niigata University Medical and Dental Hospital from January 2013 to March 2014; 36 patients were included in the TIVA group, and 35 patients were included in the TIVA + PECSB group. Intraoperative remifentanil requirements were significantly lower in the TIVA + PECSB group than in the TIVA group, and the cumulative distribution of remifentanil was reduced in patients who received PECSB (TIVA: 10.9 ± 2.9 μg/kg/h; TIVA + PECSB: 7.3 ± 3.3 μg/kg/h; p < 0.001). Postoperative pain scores during the 48 h after surgery were significantly lower in the TIVA + PECSB group than in the TIVA group (TIVA: 2 [1-5]; TIVA + PECSB: 1 [0-5]; p = 0.03). However, administration of fentanyl during operation, percentage of patients requiring supplemental analgesics, and incidence of PONV were not significantly different between groups.

Conclusions: PECSB significantly reduced intraoperative remifentanil usage and postoperative pain. However, the requirement for postoperative supplemental analgesics and the incidence of PONV did not differ. These data suggested that PECSB may be useful for perioperative pain management in patients undergoing BCS.

Figures

Fig. 1

a Average dose of intraoperative remifentanil use in the TIVA and TIVA + PECSB groups. Data are shown as the means ± SDs. ***p < 0.001 by unpaired Student’s t tests. b Histogram and cumulative probabilities of intraoperative remifentanil dose in patients who underwent BCS with TIVA or TIVA + PECSB. Red and blue bars denote the frequency of increases in intraoperative remifentanil doses (2 μg/kg/h) in the TIVA and TIVA + PECSB groups, respectively. Red triangles and purple crosses denote the cumulative distribution of intraoperative remifentanil doses in the TIVA and TIVA + PECSB groups, respectively

Fig. 2

Histogram and cumulative probabilities of maximal postoperative pain during the 48 h after surgery in patients who underwent BCS with TIVA or TIVA + PECSB. Red and blue bars denote the frequencies of NRS in the TIVA and TIVA + PECSB groups, respectively. Red triangles and purple crosses denote cumulative distributions of NRS within the 48 h after surgery in the TIVA and TIVA + PECSB groups, respectively