Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation

Hetta, Diab Fuad; Rezk, Khalid

doi:10.1016/j.jclinane.2016.04.003

Cited by 77 publications

(46 citation statements)

References 22 publications

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“…First, no trials have previously compared these 2 block techniques. While proponents of the "original" superficial serratus block have described successful analgesia without the potentially hazardous need for advancing the needle deeper toward the pleura, 3,5,8,[10][11][12][13] thoughtful consideration of anatomy arguably favors the deep serratus block as injection in the fascial plane below the serratus muscle theoretically facilitates blockade of higher-order lateral cutaneous intercostal nerves, which are known for their extensive ramification and collateral branching. 32 Our current findings encourage the transition to the deep serratus block in centers seeking alternatives for the superficial serratus block.…”

Section: Discussionmentioning

confidence: 99%

“…9 Indeed, effective analgesia, along with theoretical technical advantages, has been reported with each of these 2 block techniques for a variety of chest wall and thoracic surgeries. [1][2][3][4][5]8,[10][11][12][13][14][15] Our use of the superficial serratus plane block has posed several practical concerns to the breast oncologic surgeons, including (i) spread into the axilla, thus disrupting the surgical tissue planes; (ii) block of the long thoracic and thoracodorsal nerves, 8 thus interfering with surgeons' effort to identify these nerves (tweaking by forceps) 16 to preserve them; and (iii) needling through potentially metastatic lymph nodes, theoretically increasing the risk of tumor seeding. [17][18][19] By contrast, the deep serratus plane block performed more posteriorly, along the posterior axillary line, seems to mitigate these concerns.…”

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confidence: 99%

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Too Deep or Not Too Deep?

Abdallah

Cil

MacLean

et al. 2018

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Too Deep or Not Too Deep?

Abdallah

Cil

MacLean

et al. 2018

Regional Anesthesia and Pain Medicine

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“…Pectoral nerve block showed better results in reconstructive breast surgery, with better postoperative analgesic control in the immediate postoperative period and a lower requirement for sedation. Diab Faud Hetta [6] et al (2015) also did a similar comparative study and suggested that Pectoralis-serratus J. Evolution Med. Dent.…”

mentioning

confidence: 88%

Pectoral Nerve Block Versus Thoracic Paravertebral Block– Comparison of Analgesic Efficacy for Postoperative Pain Relief in Modified Radical Mastectomy Surgeries

Annamalai¹,

Durairaj²,

R³

2017

jemds

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BACKGROUNDModified Radical Mastectomy (MRM) is the most common surgical procedure for operable breast malignancies. Postoperative pain has been severe in MRM cases and demands for pain relief are high. The technique of performing pectoral nerve block [PECS] using ultrasound guidance is increasing in popularity. We compared the postoperative analgesic profile of ultrasound-guided serratus plane block (SPB) and landmark-guided paravertebral block (PVB). MATERIALS AND METHODSThis study was done as a double blind, randomised, controlled trial among 60 subjects with breast cancer posted for elective MRM, of which 30 subjects were put in PECS block group and 30 subjects in paravertebral block group. PVB was performed under complete aseptic precaution with low resistance technique. PECS block was performed in supine position with the U/S probe directly above 1 st rib where pectoralis major and pectoralis minor muscles are located. Anaesthesia was maintained with sevoflurane 1% and O2/N20 mixture with a fraction of 50% inspired O2. Postoperative pain was recorded using the Visual Analogue Scale (VAS) every one-hour up to 4 hours post-surgery. RESULTSThe mean VAS scores were significantly lesser in the PECS group compared to the PVB group (p<0.05). The mean heart rates in PECS group were significantly lower than PVB group throughout the procedure. There was no significant difference in the intra-OP MAP between both the groups. CONCLUSIONUltrasound-guided PECS block is an alternative analgesic technique to thoracic PVB for postop pain relief in MRM patients. It gives superior analgesia and has fewer complications. BACKGROUND Breast cancer has emerged as the most common cancer in India, and 2 nd most common even in the rural area. Breast cancer accounts for 25% to 32% of all female cancers in all these cities. This implies, practically, one fourth of all female cancer cases are breast cancers. [1] Of the several therapeutic options for breast cancer, Modified Radical Mastectomy (MRM) is the most common surgical procedure for operable breast malignancies. Postoperative pain has been severe in MRM cases and demands for pain relief are high. KEYWORDS

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“…Some blocks (such as Pecs and quadratus lumborum blocks) have undergone randomized investigation with trials of variable quality (Jadad scores raging from 2 to 4). [53][54][55][59][60][61]64,67,74 Other blocks (such as the pecto-intercostal fascial plane blocks) are still searching for a legitimate application. 65,66 A few, such as US-guided thyroid capsular sheath blocks, may never find a clinical role because of sheer interference with the surgical field.…”

Section: Limitations Of Ultrasound Guidancementioning

confidence: 99%

Beyond Ultrasound Guidance for Regional Anesthesiology

Tran

Boezaart

Neal

2017

Regional Anesthesia and Pain Medicine

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Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application. Increasingly, authors are using US to identify interfascial planes where local anesthetic can be injected thereby "discovering" new truncal blocks. Often these novel blocks suffer from a lack of proper randomized, comparative validation.Fortunately, solutions have been proposed to remedy many shortcomings associated with US guidance. The inability of US to reliably insonate deep neural structures can be circumvented with adjunctive neurostimulation. Fluoroscopy and waveform analysis have been proven to increase the success rate of thoracic epidural blocks. For continuous nerve blocks, combined US-neurostimulation may provide an objective end point (ie, an evoked motor response) for neural proximity and subparaneural positioning of the catheter tip. Finally, the solution to the plethora of nonvalidated US-guided blocks is both elegant and simple. New nerve blocks should answer a specific clinical need, and their first descriptions should take the form of an adequately powered, observer-blinded, randomized comparison against the established standard of care or, at the very least, a large case series (eg, a Brief Technical Report).

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Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation

Cited by 77 publications

References 22 publications

Too Deep or Not Too Deep?

Too Deep or Not Too Deep?

Pectoral Nerve Block Versus Thoracic Paravertebral Block– Comparison of Analgesic Efficacy for Postoperative Pain Relief in Modified Radical Mastectomy Surgeries

Beyond Ultrasound Guidance for Regional Anesthesiology

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