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Utility of Pecs Block for Perioperative Opioid-Sparing Analgesia in Cancer-Related Breast Surgery: A Randomized Controlled Trial

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Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Multidisciplinary treatment and multimodal analgesia are the approach to reduce mortality and morbidity of breast cancer. Pectoral nerve block (PECS I and II) is one of the modes of analgesia advocated. The primary aim is to find the risks and benefits of the block in providing analgesia for intraoperative and immediate postoperative cancer-related breast surgery and total morphine consumption. The secondary aim is to evaluate, any additional knowledge acquired, in the reduction of persistent chronic pain state and cancer recurrence, during the time frame studied. The study was conducted after the approval of the ethics committee and National Registry, and included patients of ASA I and II undergoing mastectomy surgery with axillary clearance, under general anesthesia, during the period of 2017 to 2018. A total of 60 patients were recruited, randomizing them into two groups: group 1 (n = 30): ultrasound-guided PECS I (0.2 ml/kg) and PECS II (0.4 ml/kg) block, post-induction with 0.25% levobupivacaine, maximum dose of 2 mg/kg; group 2 (n = 30): no block, only general anesthesia. Intraoperatively, vitals were monitored at regular intervals and analgesics given as per response. Postoperatively, pain was assessed using the numerical pain score and arm abduction score, until discharge. Data collected was analyzed and interpreted using statistical methods. Patients were followed up telephonically, until six months for any chronic pain and cancer recurrence instances. The PECS block group used less morphine intra and postoperatively, which was statistically significant (p = 0.0001). Group 1- Had a significant decrease in the mean intraoperative systolic blood pressure (p = 0.03). There was significant improvement in the arm abduction in the test group as compared to that in the control group (p = 0.001). The average time for block performance was 7.9 min and no complications were observed. No patients in the study groups reported chronic pain or cancer recurrence issues. The two-level PECS block is safe, effective, reliable, and easy to perform.

Clinical Trial Registration Number: CTRI/2017/11/010630

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Funding

As per institutional provision approved by the review board.

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Authors and Affiliations

  1. Department of Anaesthesia, Christian Medical College, Vellore, 632004, Tamil Nadu, India

    Roshan K. Kurien & Serina Ruth Salins

  2. Department of Endocrine Surgery, Christian Medical College, Vellore, 632004, Tamil Nadu, India

    Paul Mazhuvanchary Jacob

  3. Department of Medicine, Pondicherry Institute of Medical Science, Puducherry, 605014, India

    Kurien Thomas

Authors
  1. Roshan K. Kurien
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  2. Serina Ruth Salins
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  3. Paul Mazhuvanchary Jacob
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  4. Kurien Thomas
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Contributions

All the authors contributed to the conduct of the study, collection, compiling of data, literature search, and writing of the paper. The manuscript has not been published and is not under consideration for publication in any other journal. All the authors approved the manuscript and its submission to the journal, and the authors have not published or submitted any related papers from the same study.

Corresponding author

Correspondence to Serina Ruth Salins.

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taken from all patients.

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agreed by all the authors.

Institutional Review Board Approval Number

IRB Min. No:10390[INTERVEN] dated 30.11.2016.

Conflict of Interest

The authors declared no competing interests.

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Importance of the Study and Research Question Answered

Advances in Knowledge This original study was conducted in one of the premiere, over a century old, medical educational and research institutions of the country. It adds to the evidence of ongoing quest to determine ideal breast analgesia, with the use of PECS block, by reduction in opioid consumption, lower pain scores, early functionality, and discharge in the time period studied. Our study proved the safety and efficacy of this easily usable block, which advocates many practitioners, in perioperative care, to use it under the set safety guidelines.

Application to Patient Care There is significant incidence of acute and chronic postoperative pain with oncological breast surgery. Providing clinicians with an evidence-based approach, for better patient care to improve perioperative outcome and patient satisfaction, is certainly beneficial with the use of PECS block, among other modalities for analgesia.

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Kurien, R.K., Salins, S.R., Jacob, P.M. et al. Utility of Pecs Block for Perioperative Opioid-Sparing Analgesia in Cancer-Related Breast Surgery: A Randomized Controlled Trial. Indian J Surg Oncol 12, 713–721 (2021). https://doi.org/10.1007/s13193-021-01382-w

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  • DOI: https://doi.org/10.1007/s13193-021-01382-w

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