Novel use of the <scp>PECS II</scp> block for upper limb fistula surgery

Purcell, Nicole H.; Wu, Dazhou

doi:10.1111/anae.12876

Cited by 28 publications

(10 citation statements)

References 5 publications

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“…The PECS anesthetize the pectoral, the intercostobrachial, the intercostals III and VI, and the long thoracic nerves which supply the breast and axilla (Purcell and Wu 2014). Blocking those nerves provides complete analgesia after breast surgery (Ueshima and Otake 2017).…”

Section: Discussionmentioning

confidence: 99%

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

Hamed

Fawaz

Rabie

et al. 2020

Ain-Shams J Anesthesiol

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Background Thoracic 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. Objective To compare thoracic paravertebral block and pectoral nerve block for postoperative analgesia after modified radical mastectomy Methods The 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. Results Our 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 < 0.05 Conclusion The 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.

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Section: Discussionmentioning

confidence: 99%

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

Hamed

Fawaz

Rabie

et al. 2020

Ain-Shams J Anesthesiol

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“…Although this block was initially used for patients undergoing breast surgery, it has also been described for patients undergoing other superficial procedures such as pacemaker insertion 35 and upper-limb fistula surgery. 36 Wahba and Kamal 37 compared US-guided combined Pecs 1 and 2 blocks to TPVB at T4 in patients undergoing modified radical mastectomy. They found that the patients in the Pecs block group had lower intraoperative opioid requirements and better postoperative pain control.…”

Section: Discussionmentioning

confidence: 99%

Update on Ultrasound for Truncal Blocks

Abrahams

Derby

Horn

2016

Regional Anesthesia and Pain Medicine

211

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Since our last review, numerous studies have been published, especially for the paravertebral and transversus abdominis plane blocks, and 3 novel US-guided blocks (Pecs, quadratus lumborum, and transversalis fascia blocks) have been described. Although some of these studies support the use of US for performing these blocks, others do not. Additional studies have used US to improve our understanding of the anatomy pertinent to these blocks and evaluated the effect on patient outcomes and risk of complications.

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“…Application: The PECS I and PECS II blocks are used in a wide range of procedures, such as implantation of vascular catheters, intravenous ports, punctures, continuous drainage of pleural cavity (mainly PECS I); mastectomy; minimally invasive aortic valve replacement; thoracoscopy; minithoracotomy; rib fractures; postmastectomy pain syndrome; neoplastic pain; and pacemaker/cardioverter implantation (mainly PECS II) [ 5 , 8 , 9 , 10 ].…”

Section: Local Thoracic Plain Blocks—review Of Techniquesmentioning

confidence: 99%

“…The medial distribution of anesthetic for PECS I blocks allows for anesthesia of the anterior cutaneous branches of the intercostal nerves; in turn, lateral distribution may involve the lateral cutaneous branches of the intercostal nerves. In PECS II, the medial distribution increases Application: The PECS I and PECS II blocks are used in a wide range of procedures, such as implantation of vascular catheters, intravenous ports, punctures, continuous drainage of pleural cavity (mainly PECS I); mastectomy; minimally invasive aortic valve replacement; thoracoscopy; minithoracotomy; rib fractures; postmastectomy pain syndrome; neoplastic pain; and pacemaker/cardioverter implantation (mainly PECS II) [5,[8][9][10].…”

Section: Pectoral Nerve Blockmentioning

confidence: 99%

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

Szamborski

Janc

Rosińczuk

et al. 2022

IJERPH

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Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.

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Novel use of the PECS II block for upper limb fistula surgery

Cited by 28 publications

References 5 publications

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

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

Update on Ultrasound for Truncal Blocks

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

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