PECS Group Research Articles

A Comparative Study between Ultrasound Guided Pectoral Nerve Block Type II versus Intravenous Patient Controlled Analgesia for Intra-Operative and Post-Operative Analgesia in Patients Undergoing Modified Radical Mastectomy

Abstract Background Breast surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anaesthesia techniques may improve post-operative analgesia for patients undergoing breast surgery. Aim of the Work The primary aim of this study is to compare the efficacy of PECS block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques. Patients and Methods This study is a randomized clinical trial study conducted in Ain-shams University Hospitals, Cairo, Egypt for 6 months after medical ethical committee approval. The participants were allocated randomly into two groups of 25 patients each: group A: Patients received general anaesthesia followed by PECS block at the end of the operation before extubation, group B: Patients received general anaesthesia followed by the PCA at the end of surgery after extubation. Results The VAS score in the PECS group was statistically significantly lower at the 1st, 2nd and 4th hours. In this case, the use of PECS for postoperative analgesia is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect as the nausea and vomiting is significantly higher in the PCA group than the PECS group at the 6th hour, however, the need of intra operative opioids in PCA group is significant. Conclusion In modified radical mastectomy, PECS block is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, PECS block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and can decrease the need of analgesia intra-operative, however PCA analgesic effect last longer, less invasive technique and easier to be used while PECS block require hand skills and limited to 24 hours analgesia only.

Pectoral Nerve Blocks Under Direct Vision During Endoscopic-Assisted Transaxillary Breast Augmentation: A Novel, Effective Regional Blocking Approach.

Endoscopic-assisted transaxillary breast augmentation allows performing Pecs block under direct visualization. This study aimed to describe this new technique and demonstrat its short-term efficacy and safety with a preliminary clinical study. Patients enrolled for transaxillary endoscopic-assisted prosthetic breast augmentation between February 2022 and March 2023 in two medical centers were included in the pectoral nerve block group. Postoperative VAS scores at 1, 4, 12, 24, 48, and 72h, surgery duration, and the occurrence of nausea and vomiting were compared with a historical cohort of patients collected between February 2021 and January 2022 with the same inclusion criteria. 229 patients were included in the Pecs group and 116 patients were identified in the control group. No statistical difference was observed in patient characteristics. VAS score at postoperative 1h and 72h was similar between the two groups, whereas VAS score at postoperative 4h, 12h, 24h and 48h in Pecs group was significantly lower than control group. The occurrence of PONV in the Pecs group is significantly lower than in the control group. The duration of surgery is similar between the two groups. No block-related complication was observed in the Pecs group. A novel approach by combining pectoral nerve blocks with transaxillary endoscopic-assisted breast augmentation to perform blocks under direct vision was proposed and its short-term efficacy and safety was determined by this study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Postoperative Analgesic Efficacy of Intraoperative Pectoral Nerve Block for Modified Radical Mastectomy: a Double-Blind Prospective Randomised Interventional Study.

Severe acute postoperative pain following breast surgery increases the risk of persistent pain and affects the recovery of patients. Recently, pectoral nerve (PECs) block has gained significance as a regional fascial block that can provide adequate postoperative analgesia. This study aimed to evaluate the safety and efficacy of PECs II block, which was given intraoperative under direct vision after performing modified radical mastectomy for breast cancer patients. This prospective randomised study was comprised of a PECs II group (n = 30) and a control group (n = 30). Group A patients received 25ml of 0.25% bupivacaine for PECs II block intraoperatively after the surgical resection was done. Both groups were compared with respect to the demographic and clinical parameters, total intraoperative fentanyl dose, total duration of surgery, postoperative pain score (Numerical Rating Scale) and the analgesic requirement, postoperative complications, postoperative duration of hospital stay, and the outcome. Intraoperative PECs II block was not associated with any increase in the duration of surgery. The postoperative pain scores were significantly higher in the control group till 24h after the surgery, and so was the postoperative analgesic requirement. Patients in the PECs group were found to have rapid recovery and decreased postoperative complications. Intraoperative PECs II block is not only safe, time-saving procedure but also significantly reduces the postoperative pain and analgesic requirement in breast cancer surgeries. It is also associated with a faster recovery, decreased postoperative complications, and better patient satisfaction.

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study.

BackgroundPectoralis nerve blocks (PECS) have been shown in numerous studies to be a safe and effective method to treat postoperative pain and reduce postoperative opioid consumption after breast surgery. However, there are few publications evaluating the PECS block effectiveness in conjunction with multimodal analgesia (MMA) in outpatient breast surgery. This retrospective study aims to evaluate the efficacy of PECS's blocks on perioperative pain management and opioid consumption.MethodsWe conducted a retrospective study to assess the efficacy of preoperative PECS block in addition to preoperative MMA (oral acetaminophen and/or gabapentin) in reducing opioid consumption in adult female subjects undergoing outpatient elective breast surgery between 2015 and 2020. A total of 228 subjects were included in the study and divided in two groups: PECS block group (received PECS block + MMA) and control Group (received only MMA). The primary outcome was to compare postoperative opioid consumption between both groups. The secondary outcome was intergroup comparisons of the following: postoperative nausea and vomiting (PONV), incidence of rescue antiemetic medication, PACU non-opioid analgesic medication required, length of PACU stay and the incidence of 30-day postoperative complications between both groups.ResultsTwo hundred and twenty-eight subjects (n = 228) were included in the study. A total of 174 subjects were allocated in the control group and 54 subjects were allocated in the PECS block group. Breast reduction and mastectomy/lumpectomy surgeries were the most commonly performed procedures (48% and 28%, respectively). The total amount of perioperative (intraoperative and PACU) MME was 27 [19, 38] in the control group and 28.5 [22, 38] in the PECS groups (p = 0.21). PACU opioid consumption was 14.3 [7, 24.5] MME for the control group and 17 [8, 23] MME (p = 0.732) for the PECS group. Lastly, the mean overall incidence of postsurgical complications at 30 days was 3% (N = 5), being wound infection, the only complication observed in the PECS groups (N = 2), and hematoma (N = 2) and wound dehiscence (N = 1) in the control group.ConclusionPECS block combined with MMA may not reduce intraoperative and/or PACU opioid consumption in patients undergoing outpatient elective breast surgery.

Analgesic Efficacies of Intraoperative Pectoralis Nerve II Block under Direct Vision in Patients Undergoing Robotic Nipple-Sparing Mastectomy with Immediate Breast Reconstruction: A Prospective, Randomized Controlled Study.

This prospective, randomized study aimed to evaluate the efficacy of an intraoperative pectoralis nerve II block (PECS II block) under direct vision in the reduction of fentanyl consumption during postoperative 24 h in patients undergoing robotic nipple-sparing mastectomy (RNSM) with immediate breast reconstruction (IBR) using direct-to-implant (DTI) or tissue expander (TE). Thirty patients scheduled for RNSM with IBR were randomly allocated to the PECS (n = 15) or control (n = 15) groups. The PECS II block was applied under direct vision after RNSM. The primary outcome was the cumulative dose of fentanyl consumption. The secondary outcomes were pain intensity using a numerical rating scale (NRS) at rest and acting during the postoperative 24 h. The cumulative dose of fentanyl at 24 h was significantly lower in the PECS group than in the control group (p = 0.011). Patients in the PECS group showed significantly lower NRS scores during the first postoperative 2 h compared to those in the control group in both resting and acting pain (p < 0.05). An intraoperative PECS II block under direct vision can reduce opioid consumption during the postoperative 24 h and provide effective analgesia in patients undergoing RNSM with IBR using DTI or TE.

Effectiveness of Pectoral Nerve Blocks (PEC II) for Post Operative Pain Management in Breast Surgery

Background: Breast surgery is one of the most performed surgeries in Bangladesh. Though there is growing interest in using regional anaesthesia in other surgeries, the use of regional anaesthesia modalities for postoperative pain management in breast surgery is still lacking. Post operative pain in breast surgery is moderate to severe and there is increased incidence of postoperative persistent pain. In this study, the effectiveness of pectoral nerve blocks (PECs II) was assessed in comparison to no regional anaesthesia and overall impact was identified in breast surgery.Methods: This randomized controlled study was conducted from January 2022 to December 2022. Total 60 female adult patients undergoing elective unilateral modified radical mastectomy under general anesthesia were allocated in two groups. 30 patients received PEC II block with general anaesthesia and other 30 patients only received general anaesthesia. All patients received pre-emptive analgesia oral Paracetamol (1g) 1 hour before surgery and Inj. Diclofenac (75 mg) at induction. Postoperative analgesia with numerical pain rating score (NPRS), perioperative haemodynamic status with mean arterial pressure (MAP), perioperative blood loss, timing of first dose of supplemental analgesic requirement, total Morphine consumption, incidence of persistent postsurgical pain were assessed.Results: In postoperative period mean NPRS was 2.0 (± 0.3) in PECs group compared to 4.6 (± 0.9) for control group for first 24 hours. Mean timing of first dose of Morphine requirement in PECs group was 8.2 (± 0.3) hours compared with 30.5 (± 2.8) minutes after arrival in PACU for control group. Morphine consumption in 24 hours was 7.3 (± 2.1) mg for PECs group and 18.5 (± 9.5) mg in control group. Average MAP was 66.3 (± 7.4) for PECs group and 81.4 (± 4.9) for no block group in first 24 hours after surgery. Mean intraoperative blood loss in PECs group was 91.67 (± 0.5) ml and in control 215 (± 2.7) ml. Surgeon satisfaction was 71% in PECs group regarding the perioperative blood loss. The incidence of persistent postsurgical pain was 13.33% in control group with no incidence in PECs group.Conclusion: PEC II block provides an effective postoperative analgesia as part of multimodal analgesic techniques. It is also associated with positive effect on perioperative stable haemodynamic. To prevent chronic pain, PEC II block seems to be effective.

Bilateral PECS II Block is Associated with Decreased Opioid Consumption and Reduced Pain Scores for up to 24 hours After Minimally Invasive Repair of Pectus Excavatum (Nuss Procedure): A Retrospective Analysis

Objective(s)Compared to the open surgical technique, the minimally invasive repair of pectus excavatum (MIRPE; Nuss procedure) is a thoracoscopic technique designed to minimize intraoperative tissue damage. It still causes severe postoperative pain due to the insertion and pressure of the retrosternal bar used to raise the sternum and stabilize the chest. This study aimed to identify associations between ultrasound-guided PECS-II block and postoperative analgesia after the Nuss procedure. DesignA retrospective cohort study SettingSingle-center, training and research hospital affiliated with a university ParticipantsFrom Jan 1, 2018 to Nov 15, 2021, 171 consecutive patients were identified who underwent MIRPE surgery under general anesthesia. All patients received intravenous (I) patient-controlled analgesia (PCA) with or without PECS-II blocks for postoperative analgesia. One hundred twenty-five patients who met the inclusion criteria were evaluated. InterventionsDemand-only morphine intravenous PCA was used for postoperative pain management in the PECS and control groups. Bilateral PECS-II block with 0.25% bupivacaine was performed in to the PECS group. Measurements and main resultsThe primary outcome was postoperative opioid consumption, calculated as mg/kg of IV morphine. Secondary outcomes included Numeric Rating Scale (NRS) pain scores at rest (static) and with movement (dynamic) recorded 1, 4, 8, 12, 24 h after surgery. Postoperative morphine consumption was significantly lower in the PECS group than in the control group over the first 24 hours postoperatively: 0.325 mg/kg vs. 0.425 mg/kg (p<0.001). Static and dynamic NRS values were significantly lower in the PECS group for the first 12 postoperative hours (p <0.05). ConclusionsBilateral PECS-II block is associated with decreased pain scores for up to 12 hours, and with decreased opioid consumption for up to 24 hours, following minimally invasive repair of pectus excavatum (Nuss procedure) in adolescents. PECS-II block in this context has not been previously described.

Estudio comparativo entre bloqueo paravertebral torácico, bloqueo de los nervios pectorales y bloqueo del músculo erector de la columna ecoguiados para el manejo del dolor en cirugías de cáncer de mama. Estudio controlado aleatorizado

ObjectivesAchieving adequate perioperative analgesia can be challenging in patients undergoing breast surgeries due to the complex nerve supply of the breast and axilla. The study aims to investigate the efficacy of ESPB in comparison to conventional regional anesthesia techniques (TPVB and PECS). MethodsEighty female patients who were scheduled for elective MRM, with ASA scoreI-II, and aged between 18 and 60years, were included in the study. Patients were randomized into four groups: the TPVB, PECS, ESPB, and the control group. All patients in either block groups received 25ml bupivacaine 0.25% with ultrasound guidance. The control group received only opioids for perioperative pain management. The patients were observed for 48hours after surgery for the duration of analgesia (primary outcome) ResultsESPB has a shorter duration of analgesia than PECS block with no significant statistical difference compared with group TPVB. Morphine consumption is increased in ESPB compared to the PECS group, with an insignificant difference compared to group TPVB. There was an insignificant difference between the groups concerning hemodynamics and complications, with one pneumothorax case reported in the TPVB group. ConclusionPECS and ESPB represent a good alternative to TPVB for post-mastectomy analgesia with a superior analgesic effect of PECS block regarding opioid consumption, duration of the analgesia, and VAS score.

Intraoperative pectoral block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: A randomized controlled trial.

With the increasing rate of breast cancer surgery, the pain management of these patients gains importance. The aim of this study is to compare the ultrasound (US) guided thoracic paravertebral block (TPV) versus intraoperative pectoral nerve block (PECS) with a low volume local anaesthetic for postoperative analgesia after breast cancer surgery. A total of 41 patients underwent mastectomy and sentinel lymph node biopsy or modified radical mastectomy were included in this randomized controlled, single-blinded trial. The patients were divided into two groups as PECS and TPV blocks. In the PECS group, 10 ml of 0.5% bupivacaine was administered to the fascial plane by the surgeon. In the TPV group, 25 ml of 0.25% bupivacaine at T3 level was administered by the anaesthetist under US-guidance. Visual analogue scale (VAS) scores and additional analgesic requirements were recorded at postoperative 0, 6, 12, 24 and 48 h. In the TPV group, mean VAS score (VAS0) was significantly lower (p ˂ 0.001). In other time periods, there was no significant difference between the groups. It was observed that intraoperative PECS block was as effective as TPV in providing postoperative analgesia and additional analgesic requirements were similar. This result suggests PECS block may be a good alternative to TPV.

Comparison of Analgesic Efficacy of Serratus Anterior Plane Block and Pectoral Nerve Block in Patients Undergoing Breast Surgery

Objective: Breast surgery is usually associated with intense post-operative pain, which lead to chronic pain. We compared the analgesic efficacy of two ultrasound guided nerve blocks that is Pectoral nerve block (PECS) and Serratus anterior plane block (SAP) post operatively. Material and Methods: This double-blind, randomized study was done on 60 adult females, who were posted for breast surgery. General anesthesia was given with intravenous midazolam 1 mg, fentanyl 1.5 mcg/kg for premedication and then injection propofol 1–2 mg/kg and vecuronium 0.1 mg/kg. After this all patients received either ultrasound?guided PECS block at 3-4th rib Group 1 (n = 30) or SAP at 5th rib Group 2 (n = 30) with 0.375 % bupivacaine. Time when need of first rescue analgesia and tramadol consumption in 0,2,4,6,8,12,24 and 48h was noted. For pain assessment Visual analogue scale (VAS) scores and any adverse effect were recorded. Results: The mean duration of analgesia (mean ± Standard deviation [S.D.]) observed longer in the PECS group as compared to SAP group 21.6 hours v/s 23 hours (1380 ± 382 min v/s 1296 ± 232 min). The post?operative analgesic consumption was significantly higher in the SAP group (200mg) as compared to PECS group (133.3 mg)( P-value &lt; 0.001). Conclusion: Ultrasound guided SAP block is a good analgesic alternative for breast surgery, although PECS block has a better analgesic profile than SAP block. Keywords - Breast surgery, Nerve block, Pectoral nerve block, Postoperative analgesia, Serratus anterior plane block

Efficacy of bilateral PECS II block in postoperative analgesia for ultrafast track pediatric cardiac anesthesia

ABSTRACT Background Effective analgesia after cardiac surgery contributes to fast recovery, and discharge from the critical care unit. Aim: This study was conducted to evaluate PECS II block for controlling post-sternotomy pain in pediatric population in ultrafast track cardiac surgery. Methods In this double-blind, randomized control trial, 40 children, 1–5 years old, underwent cardiac surgery via median sternotomy, Group (A) control: Analgesics were administered intravenously. Group (B): received 0.25% bupivacaine at 0.5 ml/kg divided equally to both sides for PECS block. Results PECS group had lower median Modified Objective Pain Score (MOPS) immediately, two, four, and 6 h postoperatively. PECS group had lower median fentanyl utilization by 35% than the control group with median utilization of 2.72 (95% CI 2.490–2.960) mic/kg/in the first 24 hours in contrast to 4.17 (95% CI 3.834–4.516) mic/kg/in the first 24 hours in the control group (P < 0.001). First rescue analgesia was later in PECS group compared to the control group with median time (7 hours) and (2 hours), respectively. Furthermore, Pediatric Anesthesia Emergence Agitation (PAED) score was lower in the intervention group with median 9.5 and 12 in the control group (P < 0.001). PECS group had shorter ICU stay than the control group (P < 0.05), with mean ICU stay 52 hours (95% CI 43.522–62.378) compared to 80.40 hours (95% CI 64.310–96.490). Conclusion PECS block is an efficient technique that can be implemented as an integral part of fast-track cardiac surgery.

Comparative study between intraoperative and postoperative analgesic effect of ultrasound-guided thoracic paravertebral block versus pectoral nerve block in patients undergoing modified radical mastectomy: a randomized controlled trial

BackgroundThe primary goal of modified radical mastectomy is to remove cancerous cells and reduce the risk of breast cancer spreading. This operation is associated with considerable acute postoperative pain and restricted shoulder movement. If this acute pain is neglected most patients will develop chronic post-mastectomy pain, which reduces the quality of life. Regional anesthesia using ultrasound-guided paravertebral nerve block or pectoral nerve block has become an ideal addition to general anesthesia for providing analgesia after breast cancer surgery. This was a randomized clinical trial conducted between February 2018 and February 2019. This study compared between the two nerve blocks regarding the efficacy in terms of analgesic consumption.ResultsThe study included 30 female patients who were undergoing modified radical mastectomy under general anesthesia and randomly divided into 2 groups of 15 patients in each. This study showed there was a statistically significant increase in the amount of total fentanyl used intraoperatively in TPVB group than PECs group with p value = 0.008. Less VAS score in PECS group with statistically significant difference between groups at 4 h, 5 h, 6 h, and 8 h. More time needed for 1st requested rescue analgesia in PECS group with P value = 0.013. Patients in PECS group received a less total dose of fentanyl in the first 24 h postoperative with P value = 0.040. There was no statistically significant difference found between groups regarding postoperative complications.ConclusionsIn female patients undergoing breast surgeries, the PECs block can be used efficiently and safely, providing better pain relief than the TPVB and reducing intraoperative and postoperative opioids use.

Comparison of the Analgesic Effects of Ultrasound Guided Pectoral Nerve Block Type II and Erector Spinae Plane Block in Breast Cancer Surgery

Objectives: To compare the effect of ultrasound guided Pectoral Nerve Block 2 (PECs 2) and Erector Spinae Plane Block (ESP) for post op analgesia in patients undergoing Breast cancer surgery Methods: This observationally planned study included 40 patients over the age of ages of 18 who are of American Society of Anesthesiologists (ASA) I-III and scheduled for elective surgery due to breast malignancy were included in the study. PECs 2 block was applied to the patients after the induction of general anesthesia in Group 1 and ESP block was applied to the patients after the induction of general anesthesia in Group 2. In the postoperative period, visual analog scale (VAS) values, nausea, vomiting and sedation score values and analgesic doses used by all patients in the post-operative period were recorded. Results: Intraoperative and postoperative opioid consumption was statistically significantly lower in the PECs block group than in the ESP group. Postoperative analgesia time was longer in the PECs group. The number of patients requiring rescue opioid in the post-operative period was statistically significantly lower in the PECs group. There was no difference between the groups in terms of complications, mobilization time, time of discharge, postoperative nausea-vomiting (PONV) and terms of sedation. Conclusions: In patients who underwent breast surgery for malignancy, we found that the ultrasound (US) guided PECs 2 block achieved more effective postoperative analgesia compared to ESP block.

The analgesic effects of combined pectoral nerve blocks versus combined serratus anterior plane block and pecto-intercostal fascial plane block in breast surgery

Abstract Background Poorly controlled acute pain after breast surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, prolonged hospital stay and increased likelihood of chronic pain. The analgesic regimen used for postoperative pain control needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient. Objective The aim of this study is to compare the intra-operative and the post-operative analgesic effects of the thoracic interfascial plane blocks (serratus anterior plane block in combination with pecto-intercostal fascial plane block) and pectoral nerve blocks (PECS I and II)in patients undergoing non-reconstructive breast surgeries. Patients and Methods The study was conducted on 50 randomly chosen patients in Ain Shams University General Surgery Hospital after approval of the medical ethical committee. They were allocated in two groups of 25 patients each. The two groups were compared regarding analgesic outcome by using the visual analogue scaling system in the first 24 hours postoperative and the patients' satisfaction using verbal rating scale and this was the primary outcome of our study. The amount of fentanyl consumed intra-operative, time for first call for rescue analgesia and the frequency of using it were recorded and compared to achieve the secondary outcome of the study which included reducing opiods requirements and avoiding their side effects. Results The study found that the total amount of intra-operative fentanyl consumption was significantly higher in the SAPB and PIFB group than the Pecs group with the range of 100-150 versus 100-200 micg fentanyl respectively, and the VAS was significantly higher in the combination of serratus anterior plane block and pecto-intercostal fascial plane block compared to Pecs I and II at 8th, 12th and 24th hours post operatively with p value 0.018, 0.022 and 0.032 respectively, also the frequency of administration of rescue analgesia was higher in the SABP and PIFB group with the range of (2 to 3) times in PECS I and II group versus (2 to 5) in SABP/PIFB group. Besides, the first request of post-operative morphine was significantly delayed in the pectoral nerve blocks than the SABP and PIFB group with the p value (0.020). Conclusion The present study found that Pecs I and II group provided superior intra-operative and post-operative analgesic control compared to the serratus and PIFB group in patients undergoing non-reconstructive breast surgeries.

Comparison of the Effects of Pectoral Nerve Block and Local Infiltration Anesthesia on Postoperative Pain for Breast Reduction Surgery: A Prospective Observational Study.

To evaluate the effects of the Pecs II block on postoperative pain in patients undergoing breast reduction surgery. This prospective, comparative, and observational study was conducted with 53 patients, with American Society of Anesthesiologists I-II, between the ages of 18 and 65, and undergoing bilateral breast reduction surgery. The patients were divided into two groups: Pecs II block with general anesthesia (Pecs group; n = 26) and local infiltration anesthesia with general anesthesia (control group; n = 27). The patients' demographic data, duration of surgery and anesthesia, hemodynamic parameters, perioperative analgesia requirements, postoperative visual analog scale (VAS) scores (at zero, one, three, six, nine, and 12 hours postoperative), the number of patients who needed analgesia at least once, the length of the hospital stay, and block-related complications were recorded. There was no statistical difference in terms of the duration of surgery and anesthesia and hemodynamic parameters. Intraoperative total fentanyl consumption (128.85 ± 25.19 mcg in the Pecs group and 227.77 ± 44.58 mcg in the control group; P < .001) and postoperative analgesic requirement were significantly lower in the Pecs group (P < .001). The number of patients who needed analgesia at least once in the Pecs group was four (15.3%). Postoperative VAS scores were significantly lower (P < .001) and the length of the hospital stay was significantly shorter in the Pecs group (P < .001). No block-related complications were observed. Pecs II block with general anesthesia may significantly contribute to reducing intraoperative and postoperative analgesia requirements and provide long-lasting and more effective postoperative pain in breast reduction surgery.

Effect of Isolated Serum from Breast Cancer Patients with Pectoral Nerves Block on Breast Cancer Cell Line (MDA-MB-231) Apoptosis Index.

BackgroundBreast cancer (BC) is the most frequent cause of cancer death in women. The thoracic pectoral nerve (PECS) block has been described as the gold standard analgesic modality for BC surgery. It has been previously reported that PECS is associated with decreased BC recurrence post-mastectomy. Although several anesthetic drugs and techniques are used in surgical oncology, their effects on the behavior of cancer cells are yet to be known and the key question of whether the anesthetic technique affects cancer outcome remains unresolved.ObjectivesSince anesthetic drugs and techniques and post-operative pain may affect BC recurrence, this study aimed to determine whether the anesthetic choice and technique, PECS II block, affects in vitro apoptosis of the MDA-MB-231 BC cell line.MethodsTwenty-two female BC patients, 20 to 75-years-old, with the same pathologic grades were included in this study. The patients were randomly divided into two groups. The first group received propofol general anesthesia (PGA) associated with PECS and the second group received standard PGA. Blood was sampled pre and post-operation from all patients. The sera were isolated and then exposed to the MDA-MB-231 human BC cell line. The mean percentage of apoptosis indices was analyzed by flow cytometry using Annexin V-fluorescein isothiocyanate 24 hours after treatment with patients’ sera.ResultsA significant decrease was seen in the mean viability percentage of BC cell line in the PECS group, besides a significant increase in the mean percentage of necrosis and late apoptosis indices compared to the control group after exposure to sera collected from patients post-operation. Intra-group analysis of the control group showed that the exposure of the tumoral cell to post-operation sera resulted in a significant increase in the mean percentage of necrosis and late apoptosis index compared to pre-operation sera exposure. In the PECS group, the exposure of the tumoral cell to post-operation sera resulted in a significant increase in the mean percentage of cell viability and late apoptosis index compared to pre-operation sera exposure.ConclusionsIn conclusion, anesthesia and BC surgery may induce apoptosis indices in the MDA-MB-231 human BC cell line. We also found that sera collected from PECS II block patients with BC could induce more apoptosis in the MDA-MB-231 cell line compared to collected sera from systemic analgesia alone after BC surgery.

Pectoral Nerves Blocks for Post-Operative Analgesia after BreastCancer Surgery

AbstractBackground: Breast cancer is the world's most commoncancer among women, surgey is one of the main treatmentsfor this disease. Several ways to prevent post mastectomypain were used, one of them is the pectoral nerves blocks (PECs Blocks).Aim of Study: Study aimed to evaluate the efficacy ofultrasound guided Pectoral neves blocks for post-operativeanalgesia after modified radical mastectomy surgery.Patients and Methods: The study was carried out on fourtyadult female patients, who were scheduled for elective unilat-eral modified radical mastectomy, they were randomly assignedto two groups, Pectoral nerves block (Pecs) group, includedtwenty patients who received preoperative Pecs blocks (com-bination of Pecs I and Pecs II) followed by general anesthesia,and control group which included twenty patients who receivedgeneral anesthesia only.Results: It was found that VAS score was statisticallysignificant higher in control group than Pecs group. Therewas a significant difference concerning the total dose ofnalbuphine consumption in 24 hours post-operative betweenboth groups which is lower in Pecs group than in controlgroup. There was a higher satisfaction scores were obtainedin Pecs group than in control group with no detected compli-cations other than PONV.Conclusion: The Pecs blocks produce excellent analgesiawhen combined with general anesthesia for modified radicalmastectomy surgery. They are simple, easy-to-learn techniques,having easily identifiable landmarks based on good anatomicaland ultrasound knowledge, making them an excellent alterna-tive to the conventional thoracic paravertebral and neuroaxialblocks for breast surgeries. Also ultrasound guided Pecs blockssignificantly reduces VAS.

Randomized controlled trial comparing the efficacy of pectoral nerve block with general anesthesia alone in patients undergoing unilateral mastectomy

This study was conducted to evaluate the efficacy of pectoral nerve block for post-operative analgesia in breast surgery patients. This double blinded, randomized controlled trial was conducted after Clinical Trials Registry-India registration. Sixty ASA grade I-II female patients undergoing unilateral modified radical mastectomy under general anesthesia, were recruited pre-operatively in two groups. PECS group (n = 29) was given ipsilateral pectoral nerve block I & II while the CONTROL group (n = 29) directly proceeded to surgery. Our primary outcome was comparison of immediate post-operative pain scores at rest and movement. The secondary outcomes were post-operative pain scores at 2, 4, 6, 12, 18, and 24h, total intraoperative fentanyl consumption, time to rescue analgesia, post-operative nausea vomiting, and complications, if any. Categorical data was analyzed by using the chi-squared test or Fishers Exact test. Comparison of pain scores was analyzed by using the Independent sample t test. The immediate post-operative pain scores in two groups were comparable. The pain scores were also comparable at 4, 6, 12, and 24h; but statistically significantly lower in PECS group at 2 and 18h. The total intraoperative fentanyl consumption was also reduced in PECS group (P=0.009). Only 9 patients in PECS group (796.5min) as compared to 22 patients in CONTROL group (387.7min) required rescue analgesia (P = 0.001). Pectoral nerve block benefits patients undergoing mastectomy by achieving similar post-operative pain scores with decreased consumption of intraoperative and post-operative opioids. Registration. Clinical Trials Registry of India, (CTRI/2017/04/008289). ctri.nic.in.

Dexmedetomidine as an adjuvant for patients undergoing breast cancer surgery: A meta-analysis.

Background:The goal of this study was to comprehensively evaluate the analgesic and antiemetic effects of adjuvant dexmedetomidine (DEX) for breast cancer surgery using a meta-analysis.Methods:Electronic databases were searched to collect the studies that performed randomized controlled trials. The effect size was estimated by odd ratio (OR) or standardized mean difference (SMD). Statistical analysis was performed using the STATA 13.0 software.Results:Twelve published studies involving 396 DEX treatment patients and 395 patients with control treatment were included. Pooled analysis showed that the use of DEX significantly prolonged the time to first request of analgesia (SMD = 1.67), decreased the postoperative requirement for tramadol (SMD = −0.65) and morphine (total: SMD = −2.23; patient-controlled analgesia: SMD = −1.45) as well as intraoperative requirement for fentanyl (SMD = −1.60), and lower the pain score at 1 (SMD = −0.30), 2 (SMD = −1.45), 4 (SMD = −2.36), 6 (SMD = −0.63), 8 (SMD = −2.47), 12 (SMD = −0.81), 24 (SMD = −1.78), 36 (SMD = −0.92), and 48 (SMD = −0.80) hours postoperatively compared with the control group. Furthermore, the risks to develop postoperative nausea/vomiting (PONV) (OR = 0.38) and vomiting (OR = 0.54) were significantly decreased in the DEX group compared with the control group. The pain relief at early time point (2, 6, 12, 24 hours postoperatively) and the decrease in the incidence of PONV were especially obvious for the general anesthesia subgroup (P < .05) relative to local anesthesia subgroup (P >.05).Conclusion:DEX may be a favorable anesthetic adjuvant in breast cancer surgery, which could lower postoperative pain and the risk to develop PONV. DEX should be combined especially for the patients undergoing general anesthesia.

Ultrasound-guided thoracic paravertebral block vs pectoral nerve block for postoperative analgesia after modified radical mastectomy

BackgroundThoracic paravertebral block may be used for analgesia after breast surgery. Ultrasound can be used during the whole technique of paravertebral block to increase success rate and decrease its complications. As well, pectoral nerve block is now used for pain relief after modified radical mastectomy with or without axillary clearance.ObjectiveTo compare thoracic paravertebral block and pectoral nerve block for postoperative analgesia after modified radical mastectomyMethodsThe study was performed over 30 female patients that were randomly divided into 2 groups with 15 patients in group A for thoracic paravertebral block (TPVB) and 15 in group B for pectoral nerve block (PECS) with injection of total 20 ml bupivacaine 0.25% in each block. Outcome measures of the study are postoperative analgesia duration (time to first rescue analgesia (0.5 mg/kg pethidine) after administration of block) and total analgesic dose in 24 h after surgery and postoperative pain which will be assessed using a visual analog scale (VAS, 0–10 as 0 = no pain and 10 = worst imaginable pain). The vital signs and pain score will be recorded at 0, 1, 2, 4, 6, 8, 12, 18, and 24 h after surgery.ResultsOur study showed decrease in systolic blood in PVB group immediately postoperative and in the first 6 h postoperative with p value < 0.05. Less time to perform the block in PECS group with p value < 0.001. Less VAS score in PECS group with statistically significant difference between groups at 1 h, 2 h, and 4 h. More time is needed for the 1st requested rescue analgesia in PECS group with p value < 0.05. Patients in the PECS group received less total dose of pethidine with a p value < 0.05ConclusionThe PECS can be effectively and safely used, provides better relief of pain and less hemodynamic changes compared with the TPVB, and reduces postoperative analgesic consumption. Therefore, the PECS can be used safely for postoperative analgesia in patients undergoing breast surgeries with axillary dissection.