Evaluation of the Effectiveness of Modified Pectoral Nerve Blocks Type II (PECS II) for Vascular Access Port Implantation Using Cephalic Vein Venesection

Abstract

The vascular access port implantation procedure can be performed using the venesection method by inserting a catheter into the cephalic vein in the region of the deltopectoral groove. This method eliminates the need for catheter tunneling. An alternative method to infiltration anaesthesia for port implantation may be a modified pectoral nerve block type II (PECS II). This study aimed to evaluate the effectiveness of modified PECS II for vascular access port implantation using cephalic vein venesection. This retrospective observational study was conducted at the 4th Military Clinical Hospital in Wroclaw, Poland. A group of 114 patients underwent the modified PECS II block and additional cutaneous infiltration anesthesia at the incision line. Pain intensity was assessed on the NRS scale measured intraoperatively at four points. The QoR-15 questionnaire was used to assess patient satisfaction during the first 24 h after surgery. The operator’s condition assessment score was used to assess surgical conditions and operator comfort. The analysis showed that the median pain intensity during vascular port implantation was 0. A statistically significant difference in pain intensity was demonstrated between the specialist’s group and the resident’s group at the second and third measurement points (p < 0.008; p < 0.012). The mean value on the QoR-15 scale was 132. There was a significant difference between the pain scores of the groups. The mean score in the pain position in the specialist’s group was 18 points and in the resident’s group, it was 19 points (p < 0.029). In conclusion, the present study revealed that the modified PECS II block is an effective and safe method of anesthesia for Port-A-Cath implantation.

Modified Supraclavicular and Pectoral Nerves Blocks for Implantation of Intravenous Port System in Cancer Patients

“…J. Janc и соавт. в своем исследовании использовали модифицированную блокаду, комбинируя блокаду грудных нервов с местной анестезией, и показали преимущественный эффект такой комбинации [41].…”

Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

“…Tuglar et al [ 15 ] described a significant modification of the blockade called PECS-zero for breast surgery in an obese patient. Its new modifications result in greater comfort for the patient and the operator, being helpful for vascular access port implantation using cephalic vein venesection [ 16 ].…”

“…Most of these techniques can serve as the only method of anesthesia and do not require additional sedation or general anesthesia. Techniques such as PECS, SAP, TTP, and PIF blocks can be used as the only method of anesthesia and postoperative pain management for selected procedures [ 6 , 7 , 8 , 16 , 53 , 54 , 55 , 56 , 57 , 58 ]. The intercostal nerve block is mainly used for pain management [ 38 , 42 ].…”

Regional Anesthesia for the Implantation of a Subcutaneous Implantable Cardioverter-Defibrillator Using Pectoserratus Plane Block and Superficial Serratus Anterior Plane Block

“…The PSP block is a modification of the interpectoral plane block, formerly known as the pectoral nerves plane block I (PECS I); after the local anesthetic deposition between the pectoral muscles, an additional dose of a local anesthetic is administered to the fascial compartment between the pectoralis minor muscle and the serratus anterior muscle, blocking the lateral branches of the intercostal nerves Th2–Th6, the intercostobrachial nerve, and the long thoracic nerve. The PSP block can be used for the procedures described above and for more extensive breast surgery procedures (mastectomy, quadrantectomy, portacath implantation) [ 34 , 39 , 40 ].…”

“…The superficial variant of the block also includes the long thoracic and thoracodorsal nerve. Local anesthetics are administered in the fourth and fifth rib regions into the fascial space between the serratus anterior muscle and the latissimus dorsi muscle [ 38 , 40 ].…”