The Effect of Pectoralis Major Block type 1 (PECS 1) on intraoperative general anesthetic requirements and postoperative analgesic requirements for breast cancer patients Undergoing Mastectomy

Abstract

Abstract Background In describing how patients feel after surgery, Armitage stated that “slapping the patient on the face and telling him or her that it’s all over is a complete inversion of the truth” because as far as the patient is concerned, “it is often just the beginning.” Although the current armamentarium of analgesic drugs and techniques is impressive, effective management of postoperative pain still poses some unique challenges in the ambulatory setting.The increasing number and complexity of operations being performed on an outpatient basis has presented anesthesia practitioners with new challenges with respect to acute pain management.Outpatients undergoing day-care procedures require a perioperative analgesic technique that is effective, has minimal side effects, is intrinsically safe.The pectoral nerves (Pecs) block types I and II are novel techniques to block the pectoral, intercostobrachial, third to sixth intercostals, and the long thoracic nerves. They may provide good analgesia during and after breast surgery. Objective In a selected category of patients undergoing mastectomy for breast cancer, we compare the intraoperative anesthetic requirements and postoperative analgesic requirements in patients receiving PECS block type I besides general mode of anesthesia, to patients undergoing general mode of anesthesia alone, hence assessing the anesthetic and analgesic role of PECS block type I in mastectomy. Patients and Methods Type of Study: Randomized Controlled double blind Clinical Trial study. Study Setting: After obtaining approval from the medical ethical committee in Ain Shams University, this study will be conducted in Ain Shams University hospitals operating rooms. Study Period: From October 2018 to March 2019. Results Going through the process and results of our study it’s been noticed that performing the PECS block besides general anesthesia as an anesthetic and analgesic technique in patients suffering from breast cancer and undergoing mastectomy, has effectively resulted in: Decreased intraoperative general anesthetic requirements, hence avoiding all probable complications of general anesthesia, and enriching the role of regional targeted anesthesia or to be more precise combining multiple modes of anesthesia to obtain optimum results. Intraoperative vital stability due to adequate analgesia hence decreased need for intraoperative opioids administration and as a result decreased complications as delayed recovery and postoperative nausea and vomiting. Good postoperative pain control accompanied with adequate levels of satisfaction, hence decreased levels of postoperative rescue analgesic requirements (Nalbuphine). Conclusion Pecs block offers significant advantages in terms of decreased intraoperative anesthetic requirements, post-operative pain relief, post-operative rescue drug consumption, PONV and overall patient satisfaction.