Single-shot pectoral plane block vs continuous local anaesthetic infusion analgesia or both pectoral plane block and local anaesthetic infusion after breast surgery: a randomised, double blind, non-inferiority trial

Abstract

Background: Pectoral plane blocks (PECs) are increasingly used in analgesia for patients undergoing breast surgery, and were recently found to be superior to single-shot paravertebral anaesthesia.1 However, there are no data comparing PECs with the popular practice of continuous local anaesthetic wound infusion (LA infusion) analgesia for breast surgery. Therefore, we compared the efficacy and safety of PECs with LA infusion, or a combination of both in patients undergoing non-ambulatory breast cancer surgery. Methods: This single centre, prospective, randomised, double-blind trial analysed 45 women to receive either PECs (10 ml 0.25% levobupivacaine PECs I, 20 ml 0.25% levobupivacaine PECs II) (PECs group); LA infusion catheter (0.1% levobupivacaine at 10 ml hr−1 for 24 hours) (LA infusion group); or both (PECs and LA infusion). The primary outcome measure was area under the curve of pain verbal rating score while moving vs time (AUC) over 24 hours. Secondary outcomes included total opioid consumption at 24 hours. Results: AUC moving was significantly reduced in patients receiving both PECs and LA infusion 71±34 mm hr−1 vs 58±41 vs 23±20 in PECs, LA infusion, and both, respectively, P=0.002. AUC at rest was also significantly lower in patients receiving both. Total 24 hour opioid consumption (median 25–75%) was 14 mg (9–26) vs 11 (8–24) vs 9 (5–11), P=0.4. No adverse events were observed. Conclusions: The combination of both pre-incisional PECs and postoperative LA infusion provides better analgesia over 24 hours than either technique alone after non-ambulatory breast cancer surgery. Approved by the Mater Misericordiae University Hospital Research Ethics Committee. No conflicts of interest 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. BJA. 2016 Sep;117(3):382–6. http://dx.doi.org/10.1093/bja/aew223.2.Clinical Trial Registration: NCT03024697. Available from: www.clinicaltrials.gov [Accessed]