Clinical Application of Pectoralis Nerve Block II for Flap Dissection-Related Pain Control after Robot-Assisted Transaxillary Thyroidectomy: A Preliminary Retrospective Cohort Study

Abstract

Few studies have examined the clinical utility of ultrasonography-guided pectoralis nerve block II (PECS II) during wide flap dissection of a robot-assisted transaxillary thyroidectomy (RATT). We assessed the ability of PECS II to reduce postoperative pain. We retrospectively reviewed 62 patients who underwent elective RATT from December 2021 to April 2022 at Seoul St. Mary’s Hospital (Seoul, Korea). The patients were divided into a block group (n = 28, 50.9%) and no-block group (n = 27, 49.1%). Pain was measured using a visual analog scale (VAS) at 4, 10, 20, 25, 35, and 45 h after surgery, and the requirements for rescue painkillers in the post-anesthesia care unit and ward were recorded. The VAS scores did not differ significantly between the two groups at 4 h postoperatively. The block group had significantly lower VAS scores at 10 and 25 h (p = 0.017 and p = 0.034, respectively). The block group required fewer painkillers in the post-anesthesia care unit than the no-block group, although the difference was not statistically significant in the ward. PECS II may serve as a new pain relief modality and valuable addition to the current multimodal analgesic strategy for patients undergoing RATT.

Safety and Feasibility of Single-Port Trans-Axillary Robotic Thyroidectomy: Experience through Consecutive 100 Cases

“…We performed ultrasonography-guided pectoralis nerve block II before making an incision for some patients undergoing SP-TART (n = 28) and compared the visual analog scale with the no-block group (n = 27). The block group had significantly lower pain scores than the no-block group [ 30 ]. SP-TART may cause pain shortly postoperatively, but it can be overcome by a pectoralis nerve block.…”

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

“…Recent research on TAA, published in 2022, focuses on the impact of the procedure on the RLN as well as on the protection of the parathyroids and the management of postoperative pain [51][52][53]. Chen et al presented the results of a study on the impact of gasless endoscopic thyroidectomy through an axilla (GETTA) on RLN damage in thyroid cancer patients.…”

“…Chae et al presented a preliminary retrospective cohort study on the clinical application of intercostal nerve block II to control pain related to thyroid lobe detachment after thyroidectomy through the axilla using a robot [51]. Pectoralis nerve block II (PECS II) could be a useful option for pain management during robotic-assisted trans-axillary thyroidectomy (RATT) and may be used in combination with other methods for pain relief.…”

“…Analgesia during RATT may be challenging but is crucial for a successful recovery after surgery. Therefore, further research is being conducted to confirm the pain-relieving effects of PECS II and to develop a pain control scheme for patients undergoing RATT [51].…”