Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery

Wahba, Sherif Samir; Kamal, Sahar Mohammed

doi:10.1016/j.egja.2013.10.006

Cited by 130 publications

(141 citation statements)

References 25 publications

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“…The results obtained in this study are similar to the study done by Sherif Samir Wahba [7] et al in which they compared the analgesic efficacy of thoracic paravertebral block vs. pectoral nerve block for postoperative pain relief in modified radical mastectomy surgery for carcinoma breast which implies that pectoral nerve block is superior to paravertebral block in providing prolonged postoperative pain relief. Sherif Samir Wahba [7] et al (2014) selected 60 patients and divided them into two groups. One group received thoracic paravertebral block with 15-20 mL 0.25% Levobupivacaine.…”

Section: Differences In the Haemodynamic Changes Between The Two Groupssupporting

confidence: 80%

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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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Section: Differences In the Haemodynamic Changes Between The Two Groupssupporting

confidence: 80%

“…Based on intensive literature review, the mean time to rescue analgesic in a study done by SS Wahba [7] was found to be 137.5 min. (S.D 12.5) in PVB group and 175 min.…”

Section: Sample Size and Samplingmentioning

confidence: 99%

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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“…5 According to this validated system, one randomized controlled trial with a Jadad score of 3 merits a score of Ib and justifies a grade A recommendation. 6 We also agree with Dr El-Boghdadly and colleagues that the different Pecs blocks represent different target/nerves with different areas of distribution, which implies that each block, may have separate and unique indications. [7][8][9] More research on indications, techniques, efficacy, risks, and complications is needed before we can make recommendations beyond the current scoring system.…”

Section: Kariem El-boghdadly Mbbssupporting

confidence: 85%

“Update on Ultrasound for Truncal Blocks”

El‐Boghdadly

Sehmbi

Chan

2016

Regional Anesthesia and Pain Medicine

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“…Four Pecs II block studies with a median Jadad score of 3 were included in our review [105][106][107][108] (Table 4). Bashandy and Abbas 106 investigated Pecs II block versus no block for modified radical mastectomy in an observer-blinded study.…”

Section: Interfascial Plane Blocksmentioning

confidence: 99%

Perioperative Breast Analgesia

Woodworth

Ivie

Nelson

et al. 2017

Regional Anesthesia and Pain Medicine

273

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Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analgesic techniques for managing perioperative pain. We performed a systematic review of the evidence for these analgesic techniques, including intercostal block, epidural administration, paravertebral block, brachial plexus block, and novel peripheral nerve blocks.

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Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery

Cited by 130 publications

References 25 publications

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

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

“Update on Ultrasound for Truncal Blocks”

Perioperative Breast Analgesia

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