Abstract
Background and Aims: Pectoral nerve blocks gained increasing recognition for adequate postoperative pain relief following breast surgery. Traditionally, anaesthetist administered preoperatively under ultrasound guidance, which added significantly to the total procedure time. We studied the effectiveness of intraoperative direct vision pectoral nerve block and reduction of total theatre time. Methods: We provided questionnaires to the eligible patients who underwent a mastectomy and or axillary node clearance from August 2018 to May 2019. All the patients had an intra-operative pectoral 1 and serratus plane (Pecs) block. Participants documented pain score twice daily, episodes of nausea or vomiting and type and dose of analgesia for the first seven postoperative days. We compiled and grouped the results into postoperative days 1 - 2 and 3 - 7 for data analysis. Results: Patients reported generally low levels of pain, with a median pain score of 1.75 out of 10 for postoperative days 1 - 2 (IQR 4). The score decreased to 0.7 for days 3 - 7 postoperatively (IQR 3) suggesting that most patients had generally minimal levels of pain apart from a few outliers. The average injection time for PECs blocks was 5 minutes, significantly less than USS guided techniques of 20 - 30 minutes. Conclusions: Our data suggest that nerve blocks under direct vision offer satisfactory efficacy in postoperative analgesia with minimal nausea and vomiting. This is in addition to substantial benefits in operative efficiency and reduction of total procedure time.
Highlights
Postoperative analgesia for breast surgery includes a multimodal approach with intra-operative infiltration of long-acting local anaesthetics like levobupivacaine, a combination of oral and intravenous paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids when necessary
We studied the effectiveness of intraoperative direct vision pectoral nerve block and reduction of total theatre time
While general anaesthesia is still very commonly used for breast surgery, there has been a surge for regional techniques like pectoral nerve block 1 and serratus plane block (PECs block), paravertebral blocks and thoracic epidural techniques for analgesia, as well as a primary modality in patients who are high risk for anaesthesia [1]
Summary
Postoperative analgesia for breast surgery includes a multimodal approach with intra-operative infiltration of long-acting local anaesthetics like levobupivacaine, a combination of oral and intravenous paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids when necessary. Some of the studies have revealed that pectoral and serratus plane block can reduce intraoperative fentanyl requirement, postoperative pain, postoperative morphine consumption, and postoperative nausea and vomiting (PONV) among those patients undergoing breast cancer surgery [8]. The present study has presented the effectiveness of intraoperative direct vision pectoral nerve block and total theatre time reduction [11]. We studied the effectiveness of intraoperative direct vision pectoral nerve block and reduction of total theatre time. Conclusions: Our data suggest that nerve blocks under direct vision offer satisfactory efficacy in postoperative analgesia with minimal nausea and vomiting. This is in addition to substantial benefits in operative efficiency and reduction of total procedure time
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