Abstract P2-12-13: Modified pectoral nerves block for postoperative analgesia after modified radical mastectomy: A comparative study

Abstract

Background: The modified pectoral nerves block (Pecs II) as a method of analgesia for breast cancer surgery has shown excellent results in recent publications. This technique blocks the long thoracic nerve, thoracic intercostal nerves from T2-T6 & thoracodorsal nerve. Aims: To evaluate the effectiveness of the Pecs II block for pain relief in the postoperative period of patients undergoing modified radical mastectomy (MRM). Methods: A prospective comparative study was conducted at our instituition between November 2014 and March 2015. Patients scheduled to undergo MRM were randomly assigned to the test group (endotracheal anaesthesia along with Pecs II) and the control group (endotracheal anaesthesia only). In the postoperative period the patients were evaluated using a visual analogue scale to determine pain scores at 6, 12 & 24 hours. Results: Fifty patients (25 in each group), between the ages of 24 to 76 years (54.76 ± 10) were included in the study. There was no significant difference in ages between test & control groups. In the postoperative period, the test group had significantly lower median pain scores at 6, 12 & 24 hours as compared to the control group. Table 1: Comparative analysis for Pecs II block TestControlp valueeffect size (r)Average age (years)54.44 ± 10.7855.08 ± 9.370.824-Median postoperative pain scores 6 hours2 (1)6 (2)<0.001*- 0.8312 hours3 (1)5 (2)<0.001*- 0.6224 hours3 (1)0.034*- 0.30* statistically significant Conclusion: The modified pectoral nerves block (Pecs II) is a novel & effective technique for postoperative analgesia in patients undergoing modified radical mastectomy. Citation Format: Kanitkar R, Mane A, Agashe A, Kulkarni M, Deshmukh S. Modified pectoral nerves block for postoperative analgesia after modified radical mastectomy: A comparative study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-13.

Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery

“…Pectoralis-II block was performed preoperatively in 11 studies, 2,3,10,13,15,16,22,23,61-63 intraoperatively (after the induction of general anesthesia) in two, 19,64 and block timing was not specified in one study. 65 The block technique was explicitly described as two injections (between pectoral major and minor muscles, and between pectoralis minor and serratus anterior muscles) in 12 studies, 2,3,10,13,15,16,19,22,[61][62][63][64] whereas the remaining studies 23,65 cited Blanco's technique 17 without specifying that two injections were performed. In these two studies, we could not ascertain that two injections were performed, as some practitioners incorrectly refer to the injection between pectoralis minor and serratus anterior muscles as Pectoralis-II block.…”

“…The risk of bias assessment for each individual study is presented in figure 2. Of the randomized controlled trials included, three 15,23,65 did not provide sufficient information about random sequence generation (unclear risk of detection bias) and six 10,13,15,23,64,65 did not provide sufficient information about allocation concealment (unclear risk of selection bias). Furthermore, nine studies 2,3,10,13,15,22,23,62,65 did not explicitly state that participants and operators performing blocks were blinded (unclear risk of performance bias), whereas one study 64 did not blind anesthesiologists performing Pectoralis-II (high risk of performance bias).…”

“…Of the randomized controlled trials included, three 15,23,65 did not provide sufficient information about random sequence generation (unclear risk of detection bias) and six 10,13,15,23,64,65 did not provide sufficient information about allocation concealment (unclear risk of selection bias). Furthermore, nine studies 2,3,10,13,15,22,23,62,65 did not explicitly state that participants and operators performing blocks were blinded (unclear risk of performance bias), whereas one study 64 did not blind anesthesiologists performing Pectoralis-II (high risk of performance bias). One study 65 did not provide sufficient details regarding the sham blocks used (unclear risk of detection bias), and another six 2,3,10,13,62,64 did not use sham blocks at all (high risk of detection bias).…”

“…Furthermore, nine studies 2,3,10,13,15,22,23,62,65 did not explicitly state that participants and operators performing blocks were blinded (unclear risk of performance bias), whereas one study 64 did not blind anesthesiologists performing Pectoralis-II (high risk of performance bias). One study 65 did not provide sufficient details regarding the sham blocks used (unclear risk of detection bias), and another six 2,3,10,13,62,64 did not use sham blocks at all (high risk of detection bias). Three studies 15,23,65 did not provide sufficient details to assess patient loss (unclear risk of attrition bias), whereas another study 19 had less than 20% loss and did not conduct any post hoc analysis (high risk of attrition bias).…”

Pectoralis-II Myofascial Block and Analgesia: Comment

“…Among the studies listed to report on cumulative 24-h opioid consumption, another study (Lykoudi et al, 4 European Society of Regional Anesthesia Abstract 2016 -coauthor Stavropoulou E is omitted in the References section) appears without being mentioned previously as being included in the meta-analysis and without being listed in table 1. On the other hand, an abstract by Kanitkar et al, 5 which is mentioned as being selected for this meta-analysis and does in fact report on cumulative opioid consumption, is not among the studies listed to report on 24-h opioid consumption.…”