Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks

Abstract

Background: Regional nerve blocks are an integral part of multimodal analgesia and should be chosen based on their efficacy, convenience, and minimal side effects. Here, we compare the use of pectoral (PEC II) and serratus-intercostal fascial plane (SIFP) blocks in breast carcinoma cases undergoing modified radical mastectomy (MRM) in terms of the postoperative analgesic efficacy and shoulder mobility.Methods: The primary outcome of this prospective controlled study was to compare the postoperative static and dynamic pain scores, and the secondary outcome was to assess the shoulder pain, range of shoulder joint motion, and hemodynamic parameters. Sixty patients were randomly allocated to three groups and given general anesthesia. All patients received paracetamol, diclofenac, and rescue doses of tramadol based on the Institute's Acute Pain Service (APS) policy. No block was performed in group C (control), whereas groups P and S received PEC II and SIFP blocks, respectively, before surgical incision.Results: The groups were comparable in terms of age, weight, height, and body mass index distribution (P > 0.05). Dynamic pain relief was significantly better 12 and 24 h postoperatively in groups P (P = 0.034 and P = 0.04, respectively) and S (P = 0.01 and P = 0.02, respectively) compared to group C. Shoulder pain relief and shoulder mobility were better in group S, while the hemodynamic parameters were more stable in group P.Conclusions: Both SIFP and PEC blocks have comparable dynamic and static pain relief with better shoulder pain scores in patients receiving SIFP.

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

“…The secondary endpoints were the resting and acting pain intensity using NRS at 0, 1, 2, 4, 6, 8, 12, and 24 h after surgery. Resting pain was defined as pain at rest or lying still, and acting pain was defined as pain when moving or changing posture or coughing [ 17 ].…”

Transparency considerations for describing statistical analyses in research

“…Another example of a statistical analysis section, taken from a study conducted by Kaur et al [ 2 ], is as follows:…”

New peripheral nerve blocks and local anesthetics

“…If the block is performed under the serratus anterior muscle, it is named serratus-intercostal fascial plane block, and the lateral and anterior cutaneous branches of the thoracic intercostal nerves are blocked. In a randomized, controlled study comparing serratus-intercostal fascial plane block, Pectoral nerve block II, and the control group, it was determined that both blocks were superior to the control group regarding postoperative dynamic pain, whereas serratus-intercostal fascial plane block was more effective for postoperative shoulder pain [11] (Table 1).…”