Pectoral nerve versus erector spinae block for breast surgeries: A randomised controlled trial

Chandni Sinha, Amarjeet Kumar, Ajeet Kumar, Chandrakant Prasad, Prashant Kumar Singh, Diti Priya, Chandni Sinha, Amarjeet Kumar, Ajeet Kumar, Chandrakant Prasad, Prashant Kumar Singh, Diti Priya

Abstract

Background and aims: Patients undergoing breast cancer surgeries face significant post-operative pain. We aimed to compare pectoral nerve (PECS) block with erector spinae (ESP) block in these patients in terms of analgesic efficacy and adverse effects.

Methods: Sixty four American Society of Anesthesiologists' status I and II female patients between age 18 to 60 years scheduled for unilateral modified radical mastectomy (MRM) under general anaesthesia, were enrolled in this prospective randomised study. Patients in group I received ultrasound guided (USG) ESP block (20 cc 0.2% ropivacaine) while group II received USG guided PECS II block (25 cc 0.2% ropivacaine). General anaesthesia was administered in a standardised manner to both the groups. The various parameters observed included sensory blockade, duration of analgesia and any adverse effects. The primary outcome was the total morphine consumption in 24 hours.

Results: The total morphine consumption in 24 hours was less in group II (4.40 ± 0.94 mg), compared to group I (6.59 ± 1.35 mg; P = 0.000). The mean duration of analgesia in patients of group II was 7.26 ± 0.69 hours while that in the group I was 5.87 ± 1. 47 hours (P value = 0.001). 26 patients in group II (PECS) had blockade of T2 as compared to only 10 patients in group I. (P value = 0.00). There was no incidence of adverse effects in either group.

Conclusion: PECS II block is a more effective block when compared to ESP block in patients of MRM in terms of postoperative analgesia and opioid consumption.

Keywords: Analgesia; erector spinae block; modified radical mastectomy; pectoral block.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Consort flow chart
Figure 2
Figure 2
Intraoperative tend of MAP
Figure 3
Figure 3
Intraoperative trend of HR

References

    1. Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: A meta-analysis of randomized controlled trials. Br J Anaesth. 2010;105:842–52.
    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;59:470–5.
    1. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621–7.
    1. 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;40:68–74.
    1. Khemka R, Chakrborty A, Agrawal S, Ahmed R. Is COMBIPECS the answer to perioperative analgesia for breast surgery? A double blinded randomized controlled trial. Indian J Anaesth. 2019;63:530–6.
    1. Altiparmak B, Korkmaz Toker M, Uysal Aİ, Turan M, Gümüş Demirbilek S. Comparison of the effects of modified pectoral nerve block and erector spinae block on postoperative opioid consumption and pian scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61–5.
    1. Kwekkeboom K. Postmastectomy pain syndromes. Cancer Nurs. 1996;19:37–43.
    1. Vecht CJ, van de Brand HJ, Wajer OJ. Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve. Pain. 1989;38:171–6.
    1. Wahba SS, Kamal SM. Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery. Egypt J Anaesth. 2014;30:129–35.
    1. Bakshi SG, Karan N, Parmar V. Pectoralis block for breast surgery: A surgical concern? Indian J Anaesth. 2017;61:851–2.
    1. 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;117:382–6.
    1. Gürkan Y, Aksu C, Kusş A, Yörükogğlu UH, Kılıç CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth. 2018;50:65–8.
    1. Singh S, Kumar G, Akhileshwar Ultrasound-guided erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomised control study. Indian J Anaesth. 2019;63:200–20.
    1. Wijayasinghe N, Andersen KG, Kehlet H. Analgesic and sensory effects of the pecs local anesthetic block in patients with persistent pain after breast cancer surgery: A pilot study. Pain Pract. 2017;17:185–91.

Source: PubMed

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