Original ContributionComparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial☆
Introduction
Breast cancer is the most common malignancy of women all over the world. Female breast cancer statistics show that 1 in 8 women in the United States develop breast cancer during their lifetime [1]. Unfortunately, two-thirds of women who undergo breast cancer surgery are reported to develop chronic pain in the postoperative period [2]. Surgery type, radiation therapy, and clinically acute pain are the most important risk factors for the development of more intense chronic pain [3]. Hence, different analgesia techniques including local anesthetic infiltration, intercostal block, paravertebral block, thoracic epidural anesthesia, and pectoral nerve block (PECS) have been described to attenuate acute postoperative pain [4].
Modified pectoral nerve block (PECS II) is an interfascial block technique, which was described by Blanco et al. [5]. It has been previously shown to provide effective analgesia after mastectomy surgery [4,6]. Ultrasound-guided erector spinae plane (US-ESP) block is a novel analgesic technique that was recently described by Forero et al. [7]. Some case studies [8,9], and recently, a clinical study [10] reported effective postoperative pain reduction after radical mastectomy surgery. However, the efficacy of ESP block has not yet been compared with another block technique.
In this study, our primary aim was to compare the effects of ultrasound-guided modified PECS block and ESP block on postoperative opioid consumption of patients undergoing unilateral modified radical mastectomy surgery with axillary lymph node dissection. Our secondary aim was to compare the intraoperative fentanyl need and postoperative pain scores of the patients in the different groups.
Section snippets
Study design
After obtaining approval of the Intuitional Ethical Committee, the study was designed as a prospective, randomized, controlled, single-blind trial in an academic university hospital, and was conducted in accordance with the principles outlined in the Declaration of Helsinki. The trial is registered to the Australian New Zealand Clinical Trials Registry (Trial Id: ACTRN126118001002279). Written informed consents were obtained from all participants both for the interventions and enrollment into
Results
A total of 48 women were screened for the study. Four of the patients declined block procedures, two were found to have uncontrolled hypertension, and two patients had uncontrolled diabetes mellitus, all of whom were excluded from the study. The remaining 40 patients were allocated into the study groups. Two patients in PECS group were lost during follow-up due to mechanical problems in the PCA device. Consequently, the results of 18 patients in the PECS group and 20 patients in ESP group were
Discussion
In the current study, US PECS block reduced postoperative opioid consumption significantly more than ESP block. Besides, postoperative pain scores and rescue analgesic consumptions were significantly lower in the PECS group. However, intraoperative fentanyl need and hemodynamic parameters did not differ between the groups. The incidence of injection pain related to block interventions was similar between the groups.
The modified PECS block affects the lateral and medial pectoral nerves,
Conclusion
Ultrasound-guided modified PECS block reduced postoperative tramadol consumption and pain scores more effectively than ESP block in the first 24 h after elective unilateral radical mastectomy surgery. However, the optimum dose and concentration of local anesthetic agent is still unclear for ESP block.
Conflict of interest
The authors have no conflict of interest to declare.
Funding
The authors received no funding for this study.
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Cited by (117)
Mastectomy with axillary curage
2023, Anesthesie et ReanimationA comparative study between ultrasound-guided thoracic paravertebral block, pectoral nerves block, and erector spinae block for pain management in cancer breast surgeries. A randomized controlled study
2022, Revista Espanola de Anestesiologia y ReanimacionCOMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH INTERCOSTAL NERVE BLOCK FOR TRAUMA-ASSOCIATED CHEST WALL PAIN
2022, Journal of Emergency MedicineCitation Excerpt :Although the underlying analgesic mechanism is not well defined, ESPB has been studied as an effective technique for management of postoperative pain in different types of thoracic surgery (15). ESPB has been found to be effective in pain associated with breast surgery compared with pectoralis nerve block, with cardiac surgery compared with EA, with video-assisted thoracoscopic surgery compared with PVB, and with minimally invasive thoracic surgery compared with serratus anterior plane block (16–19). In all of those studies, ESPB was either noninferior or superior to the more specific and sophisticated aforementioned techniques, making this method an interesting choice for surgeons and intensivist physicians.
Erector spinae plane block for postoperative pain
2024, Cochrane Database of Systematic ReviewsInterpectoral and Pectoserratus Plane Block vs. Local Anesthetic Infiltration for Partial Mastectomy: A Prospective Randomized Trial
2024, Pain Research and ManagementSerratus anterior plane block (posterior approach) versus erector spinae plane block in modified radical mastectomy; A randomized comparative trial
2024, Egyptian Journal of Anaesthesia
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Declarations of interest: none.