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

Hamed, Islam Gamal; Fawaz, Ahmed Ali; Rabie, Ahmed; Aziz, Abd El Aziz Abdallah Abd El; Ashoor, Tarek M

doi:10.1186/s42077-020-00081-y

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…After review, a further 1116 studies were excluded as not meeting our predefined criteria. Finally, 62 studies evaluating nine different regional analgesia techniques were used for the quantitative analysis 14–75 . The regional and local analgesia techniques were: erector spinae plane (ESP) block, local anaesthetic infiltration, paravertebral block (PVB), pectoserratus plane (PS) block, superficial serratus anterior plane (sSAP) block, retrolaminar block, deep serratus anterior plane (dSAP) block, rhomboid plane block, interpectoral-pectoserratus (IP-PS) block.…”

Section: Resultsmentioning

confidence: 99%

Single-injection regional analgesia techniques for mastectomy surgery

Cassai

Zarantonello

Geraldini

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Patients undergoing mastectomy surgery experience severe postoperative pain. Several regional techniques have been developed to reduce pain intensity but it is unclear, which of these techniques is most effective.OBJECTIVES To synthesise direct and indirect comparisons for the relative efficacy of different regional and local analgesia techniques in the setting of unilateral mastectomy. Postoperative opioid consumption at 24 h, postoperative pain at extubation, 1, 12 and 24 h, postoperative nausea and vomiting were collected.DESIGN Systematic review with network meta-analysis (PROSPERO: CRD42021250651).DATA SOURCE PubMed, Scopus, the Cochrane Central Register of Controlled Trials (from inception until 7 July 2021).ELIGIBILITY CRITERIA All randomised controlled trials investigating single-injection regional and local analgesia techniques in adult patients undergoing unilateral mastectomy were included in our study without any language or publication date restriction.RESULTS Sixty-two included studies randomising 4074 patients and investigating nine techniques entered the analysis. All techniques were associated with less opioid consumption compared with controls The greatest mean difference [95% confidence interval (CI)] was associated with deep serratus anterior plane block: mean difference -16.1 mg (95% CI, -20.7 to -11.6). The greatest reduction in pain score was associated with the interpectoral-pectoserratus plane block (mean difference -1.3, 95% CI, -1.6 to -1) at 12 h postoperatively, and with superficial serratus anterior plane block (mean difference -1.4, 95% CI, -2.4 to -0.5) at 24 h. Interpectoral-pectoserratus plane block resulted in the greatest statistically significant reduction in postoperative nausea/vomiting when compared with placebo/no intervention with an OR of 0.23 (95% CI, 0.13 to 0.40).CONCLUSION All techniques were associated with superior analgesia and less opioid consumption compared with controls. No single technique was identified as superior to others. In comparison, local anaesthetic infiltration does not offer advantages over multimodal analgesia alone.TRIAL REGISTRATION PROSPERO (CRD4202125065).

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Section: Resultsmentioning

confidence: 99%

Single-injection regional analgesia techniques for mastectomy surgery

Cassai

Zarantonello

Geraldini

et al. 2021

European Journal of Anaesthesiology

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“…It can also affect areas of the long thoracic and thoracodorsal nerves from potential compartment spaces 24 . Therefore, there are studies showing the efficacy of PECS I block in reducing postoperative pain in surgeries such as MRM 25,26 . Wahba et al 13 compared the analgesic effect and additional analgesic consumption of PECS I and TPV in women undergoing MRM.…”

Section: Discussionmentioning

confidence: 99%

“…24 Therefore, there are studies showing the efficacy of PECS I block in reducing postoperative pain in surgeries such as MRM. 25,26 Wahba et al 13 compared the analgesic effect and additional analgesic consumption of PECS I and TPV in women undergoing MRM. They observed that patients treated with PECS block within the first 24 h after surgery consumed significantly less morphine than those in the TPV group, and reported a longer time to first morphine request in the PECS group.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative pectoral block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: A randomized controlled trial

Sagün

Rumeli

Özdemır

et al. 2022

Journal of Surgical Oncology

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Background and Methods With the increasing rate of breast cancer surgery, the pain management of these patients gains importance. The aim of this study is to compare the ultrasound (US) guided thoracic paravertebral block (TPV) versus intraoperative pectoral nerve block (PECS) with a low volume local anaesthetic for postoperative analgesia after breast cancer surgery. A total of 41 patients underwent mastectomy and sentinel lymph node biopsy or modified radical mastectomy were included in this randomized controlled, single‐blinded trial. The patients were divided into two groups as PECS and TPV blocks. In the PECS group, 10 ml of 0.5% bupivacaine was administered to the fascial plane by the surgeon. In the TPV group, 25 ml of 0.25% bupivacaine at T3 level was administered by the anaesthetist under US‐guidance. Visual analogue scale (VAS) scores and additional analgesic requirements were recorded at postoperative 0, 6, 12, 24 and 48 h. Results In the TPV group, mean VAS score (VAS0) was significantly lower (p ˂ 0.001). In other time periods, there was no significant difference between the groups. Conclusions It was observed that intraoperative PECS block was as effective as TPV in providing postoperative analgesia and additional analgesic requirements were similar. This result suggests PECS block may be a good alternative to TPV.

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“…[ 15 16 ] However, most of the studies have been done on patients undergoing mastectomy or breast conservation surgeries. [ 17 18 19 20 ] To our knowledge, this study is the first to assess the efficacy of PEC blocks in fibroadenoma surgeries.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial to study the efficacy and safety of ultrasound-guided pectoral nerve block for superficial breast surgeries

Nazir

Saxena

Singh

et al. 2022

Journal of Education and Health Promotion

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BACKGROUND: Our study aimed to compare pectoral nerve (PEC) block with local anesthetic (LA) infiltration for providing analgesia in superficial breast surgeries. MATERIALS AND METHODS: This prospective comparative randomized study included seventy American Society of Anesthesiologists I and II female patients undergoing excision of fibroadenoma. In Group 1, the LA mixture was infiltrated in the desired planes. In Group 2, PEC I and PEC II blocks were performed under ultrasound guidance. Patients were observed at regular time intervals for pain scores, time to first analgesic request, and the number of patients requiring rescue analgesia with the cumulative analgesic requirement, hemodynamic changes, and any adverse events. RESULTS: The patients were comparable in demographic profile, duration of anesthesia, and hemodynamic parameters. NRS scores at all times after extubation were significantly lower in Group 2 as compared to Group 1 (P < 0.0001). All patients in Group 1 required additional analgesia, while only two in Group 2 received rescue analgesia (P < 0.0001). The time to first analgesic request was significantly longer in Group 1 as compared to group 2 (9.5 + 0.70 h vs. 1.35 + 0.83 h) (P < 0.0001). The cumulative requirement of tramadol in Group 1 (96.88 ± 16.45 mg) was significantly higher than in Group 2 (6.47 ± 26.38 mg) (P < 0.0001). No adverse event was reported in either group. CONCLUSION: PEC block is a useful method for achieving effective and long-lasting analgesia. It is an efficient and safe alternative to LA infiltration in patients undergoing fibroadenoma excision.

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

Cited by 6 publications

References 15 publications

Single-injection regional analgesia techniques for mastectomy surgery

Single-injection regional analgesia techniques for mastectomy surgery

Intraoperative pectoral block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: A randomized controlled trial

Randomized controlled trial to study the efficacy and safety of ultrasound-guided pectoral nerve block for superficial breast surgeries

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