The role of pectoral nerve blocks in a day-case mastectomy service: A prospective cohort study

Bell, Ashleigh; Ali, Oroog; Robinson, A; Aggarwal, Amitabh; Blundell, Michael; Townend, Alice; Aspinall, Sebastian

doi:10.1016/j.amsu.2019.10.019

Cited by 9 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In terms of non-level-1 evidence studies, several cohort studies demonstrated the efficacy of PECS II in reducing post-operative pain and opioid consumption compared to both controls (general anesthesia only), and serratus anterior plane blocks. 56 – 58 Several case reports show that PECS II provided sufficient analgesia without GA in patients undergoing breast conserving surgery. 59 , 60 However, the evidence for using PECS II without GA is sparse and should only be considered as a last resort option.…”

Section: Resultsmentioning

confidence: 99%

Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

ElHawary

Joshi

Janis

2020

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Summary: Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.

show abstract

Section: Resultsmentioning

confidence: 99%

Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

ElHawary

Joshi

Janis

2020

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…The results of our study differ slightly from some recently published evidence showing the efficacy of PECS block on reducing perioperative opioid use in subjects undergoing breast surgery. The vast majority of prospective and retrospective studies, systematic reviews, and meta-analysis published in recent years have shown that the combination of general anesthesia and PECS blocks reduces the severity of postoperative pain and perioperative opioid consumption, and positively impact other postoperative outcomes such as PONV and the length of hospital stay when compared to MMA strategies without loco-regional anesthesia techniques ( 16 – 19 , 21 – 26 , 30 , 31 , 41 – 45 ). Therefore, the addition of PECS blocks to general anesthesia may provide adequate postoperative analgesia and substantially reduce perioperative opioid consumption ( 17 , 18 , 24 , 27 , 30 , 42 , 43 , 46 ).…”

Section: Discussionmentioning

confidence: 99%

“…The fact that opioid consumption in our study was comparable between groups most likely did not allow for a significant inter-group difference in PONV. Several clinical studies and meta-analysis showing a significant impact of PECS blocks on opioid consumption have reported a marked reduction in PONV frequency when compared with control groups or with MMA regimens without peripheral nerve block ( 19 , 26 , 28 , 30 , 31 , 45 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study

et al. 2022

View full text Add to dashboard Cite

BackgroundPectoralis nerve blocks (PECS) have been shown in numerous studies to be a safe and effective method to treat postoperative pain and reduce postoperative opioid consumption after breast surgery. However, there are few publications evaluating the PECS block effectiveness in conjunction with multimodal analgesia (MMA) in outpatient breast surgery. This retrospective study aims to evaluate the efficacy of PECS's blocks on perioperative pain management and opioid consumption.MethodsWe conducted a retrospective study to assess the efficacy of preoperative PECS block in addition to preoperative MMA (oral acetaminophen and/or gabapentin) in reducing opioid consumption in adult female subjects undergoing outpatient elective breast surgery between 2015 and 2020. A total of 228 subjects were included in the study and divided in two groups: PECS block group (received PECS block + MMA) and control Group (received only MMA). The primary outcome was to compare postoperative opioid consumption between both groups. The secondary outcome was intergroup comparisons of the following: postoperative nausea and vomiting (PONV), incidence of rescue antiemetic medication, PACU non-opioid analgesic medication required, length of PACU stay and the incidence of 30-day postoperative complications between both groups.ResultsTwo hundred and twenty-eight subjects (n = 228) were included in the study. A total of 174 subjects were allocated in the control group and 54 subjects were allocated in the PECS block group. Breast reduction and mastectomy/lumpectomy surgeries were the most commonly performed procedures (48% and 28%, respectively). The total amount of perioperative (intraoperative and PACU) MME was 27 [19, 38] in the control group and 28.5 [22, 38] in the PECS groups (p = 0.21). PACU opioid consumption was 14.3 [7, 24.5] MME for the control group and 17 [8, 23] MME (p = 0.732) for the PECS group. Lastly, the mean overall incidence of postsurgical complications at 30 days was 3% (N = 5), being wound infection, the only complication observed in the PECS groups (N = 2), and hematoma (N = 2) and wound dehiscence (N = 1) in the control group.ConclusionPECS block combined with MMA may not reduce intraoperative and/or PACU opioid consumption in patients undergoing outpatient elective breast surgery.

show abstract

“…A recent retrospective study by Chiu et al clearly showed a drastic reduction in PONV occurrence after the initiation of ERAS pathways for total mastectomy compared with a non-ERAS cohort (28% vs. 50%, respectively; p<0.001) (107). The use of regional nerve blocks (e.g., pectoral blocks or PECS, paravertebral, erector spinae plane block, and interfascial plane block) as a central component of multimodal opioid-free perioperative analgesia has had a significant impact on the frequency of PONV after breast surgery (110)(111)(112)(113)(114).…”

Section: Anesthetic Management and Postoperative Nausea And Vomiting ...mentioning

confidence: 99%

Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis

2022

View full text Add to dashboard Cite

Postoperative nausea and vomiting (PONV) have been widely studied as a multifactorial entity, being of female gender the strongest risk factor. Reported PONV incidence in female surgical populations is extremely variable among randomized clinical trials. In this narrative review, we intend to summarize the incidence, independent predictors, pharmacological and non-pharmacological interventions for PONV reported in recently published clinical trials carried out in female patients undergoing breast and gynecologic surgery, as well as the implications of the anesthetic agents on the incidence of PONV. A literature search of manuscripts describing PONV management in female surgical populations (breast surgery and gynecologic surgery) was carried out in PubMed, MEDLINE, and Embase databases. Postoperative nausea and vomiting incidence were highly variable in patients receiving placebo or no prophylaxis among RCTs whereas consistent results were observed in patients receiving 1 or 2 prophylactic interventions for PONV. Despite efforts made, a considerable number of female patients still experienced significant PONV. It is critical for the anesthesia provider to be aware that the coexistence of independent risk factors such as the level of sex hormones (pre- and postmenopausal), preoperative anxiety or depression, pharmacogenomic pleomorphisms, and ethnicity further enhances the probability of experiencing PONV in female patients. Future RCTs should closely assess the overall risk of PONV in female patients considering patient- and surgery-related factors, and the level of compliance with current guidelines for prevention and management of PONV.

show abstract

The role of pectoral nerve blocks in a day-case mastectomy service: A prospective cohort study

Cited by 9 publications

References 9 publications

Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study

Postoperative Nausea and Vomiting in Female Patients Undergoing Breast and Gynecological Surgery: A Narrative Review of Risk Factors and Prophylaxis

Contact Info

Product

Resources

About