Abstract
Objective: We administered intraoperative pectoral nerve block after tissue resection was over and assessed its analgesic efficacy with conventional post-operative intravenous opioids in patients undergoing modified radical mastectomy. Methods: Sixty patients undergoing modified radical mastectomy surgery were enrolled in this prospective, randomized, and doubleblinded study. After general anesthesia and surgical resection in both groups, Group P received pectoralis (PECS) block under vision with ropivacaine at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoral major and minor at the level of the third rib and Group T received tramadol (75 mg) in thrice daily frequency and 2% lignocaine infiltration at suture site. Primary objectives were to assess visual analog scale (VAS) scores over 24 h, time to first request for rescue analgesia (ketorolac) and total dose of analgesics needed, and secondary outcome was adverse effects and patient satisfaction score. “Mann–Whitney U test” and “Chi-square/Fischer exact test” were used for quantitative and categorical variables, respectively. Results: The mean time to the first rescue analgesia was 1175±120.21 and 1175±77.35 min and total analgesia requirement was equal (30.00±0.00 mg) in Group P and Group T, respectively. The mean VAS score over 24 h was comparable in both the groups. PECS block group had significantly less adverse effects and better satisfaction score. Conclusion: PECS block has similar analgesic efficacy as opioids but with better ability to mobilize the respective arm, better patient satisfaction score, and lesser adverse effects.
Highlights
Almost 43% patients with breast cancer require mastectomy
There are studies reported in which PECS block when administered before general anesthesia (GA), led to the spread of local anesthetics (LAs) along the fascial planes and limited the use of electrocautery during surgery
We evaluated and compared the efficacy of intraoperative PECS block with the standard practice of LA infiltration and intravenous tramadol
Summary
Almost 43% patients with breast cancer require mastectomy. Analgesic protocols used to treat post-mastectomy pain vary significantly. Perioperative analgesia utilizes significant quantities of opioids in these categories of patients This leads to an increase in opioid related side effects. Regional anesthesia includes various nerve blocks such as paravertebral block, thoracic epidural, and pectoralis (PECS) block Besides these infiltrations with local anesthesia performed by surgeon helps. Ultrasound-guided pectoral nerves blocks (Type I and II) has better analgesic quality in post-operative period with lesser adverse effects such as postoperative nausea and vomiting (PONV) when compared to opioids [2]. It requires trained personnel and an ultrasound machine [3]. Considering the above fact in to account our objectives was to report the true clinical effectiveness of both the analgesic practices by balancing the invasiveness of the analgesic interventions, as well as their adverse effects
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