Ultrasound-Guided Transversus Thoracic Muscle Plane-Pectoral Nerve Block for Postoperative Analgesia After Modified Radical Mastectomy: A Comparison with the Thoracic Paravertebral Nerve Block

Abstract

Background: Modified radical mastectomy (MRM) is a most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain even last for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM.Methods: In this randomized controlled pilot trial, eighty female breast cancer patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n=40) or TPVB (TPVB group, n=40). The primary outcome was 24 h postoperative fentanyl consumption. Secondary outcome measures included intraoperative fentanyl and postoperative flurbiprofen axetil consumption, duration of analgesia, pain intensity at rest and during activity, inflammatory response, and the quality of recovery 40 (QoR-40) score.Results: Intraoperative fentanyl requirement was similar between the two groups; Postoperative fentanyl consumption was decreased in the TTP-PECS group copmared with the TPVB group, as well as the rate of postoperative flurbiprofen axetil consumption, but the duration of analgesia was longer; Pain scores at rest and during activity were dramatically decreased at postoperative 12 h; Moreover, the levels of IL-6, MCP-1 and TNF-α, as well as the levels of PGE2, NPY and β-endorphins were decreased at 12 h after surgery; Finally, the total QoR-40 score, especially for the scores of pain, emotional state and patient support were increased.Conclusion: Both TTP-PECS and TPVB are effective for analgesia after MRM. However, TTP-PECS reduced postoperative fentanyl and flurbiprofen axetil consumption in the first 24 h after MRM, and prolonged the duration of analgesia. Furthermore, TTP-PECS reduced postoperative pain intensity at rest and during activity, and inflammatory response at 12 h postoperation. Finally, TTP-PECS improved QoR-40 scores on the postoperative day. Thus, TTP-PECS is an attractive alternative to TPVB for postoperative analgesia after MRM.

Ultrasound-guided thoracic paravertebral nerve block in patients undergoing radical mastectomy

“…Furthermore, compared with the traditional surface location and nerve stimulator guidance method, the ultrasoundguided visualization technique is highly effective, convenient and associated with fewer complications. Ultrasound-guided nerve blocks can allow anesthesiologists to focus directly on the direction of the puncture needle, needle insertion, needle tip position, and the spread of local anesthetics, thus reducing the complications caused by puncture while improving the success rate of the procedure [10][11][12][13].…”