Skip to main content

Advertisement

Log in

Comparison of PECS II and erector spinae plane block for postoperative analgesia following modified radical mastectomy: Bayesian network meta-analysis using a control group

  • Review Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

The present study compared the effects of pectoral nerve block II (PECS II) and erector spinae plane (ESP) block for postoperative analgesia in patients who underwent modified radical mastectomy by performing a network meta-analysis (NMA) using indirect comparison with systemic analgesia. Studies comparing the analgesic effects of PECS II and ESP block were searched on MEDLINE, PubMed, EMBASE and the Cochrane Library. The primary outcome of this study was cumulative opioid consumption for 24 h postoperatively. Pain score during this period was also assessed. NMA was performed to compare the postoperative analgesic effects of plane blocks and systemic analgesia. A search of databases identified 17 studies, with a total of 1069 patients, comparing the analgesic efficacies of PECS II block, ESP block, and systemic analgesia. Compared with systemic analgesia, mean difference of opioid consumption was − 10 mg (95% credible interval [CrI] − 15.0 to − 5.6 mg) with PECS II block and − 5.7 mg (95% CrI − 11.0 to − 0.7 mg) with ESP block. Relative to systemic analgesia, PECS II block showed lower pain scores over the first postoperative 24 h, whereas ESP block did not. PECS II block showed the highest surface under the cumulative ranking curves for both opioid consumption and pain score. Both PECS II and ESP blocks were shown to be more effective than systemic analgesia regarding postoperative analgesia following modified radical mastectomy, and between the two blocks, PECS II appeared to have favorable analgesic effects compared to ESP block.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fecho K, Miller NR, Merritt SA, Klauber-Demore N, Hultman CS, Blau WS. Acute and persistent postoperative pain after breast surgery. Pain Med. 2009;10:708–15.

    Article  PubMed  Google Scholar 

  2. Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain. 2011;12:725–46.

    Article  PubMed  Google Scholar 

  3. Macdonald L, Bruce J, Scott NW, Smith WC, Chambers WA. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer. 2005;92:225–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Abdallah FW, Morgan PJ, Cil T, McNaught A, Escallon JM, Semple JL, et al. Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection. Anesthesiology. 2014;120:703–13.

    Article  CAS  PubMed  Google Scholar 

  5. Woodworth GE, Ivie RMJ, Nelson SM, Walker CM, Maniker RB. Perioperative breast analgesia: a qualitative review of anatomy and regional techniques. Reg Anesth Pain Med. 2017;42:609–31.

    Article  PubMed  Google Scholar 

  6. Hussain N, Brull R, McCartney CJL, Wong P, Kumar N, Essandoh M, et al. Pectoralis-II myofascial block and analgesia in breast cancer surgery: a systematic review and meta-analysis. Anesthesiology. 2019;131:630–48.

    Article  PubMed  Google Scholar 

  7. Lovett-Carter D, Kendall MC, McCormick ZL, Suh EI, Cohen AD, De Oliveira GS. Pectoral nerve blocks and postoperative pain outcomes after mastectomy: a meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2019;44:923–8.

    Article  Google Scholar 

  8. Versyck B, van Geffen GJ, Chin KJ. Analgesic efficacy of the Pecs II block: a systematic review and meta-analysis. Anaesthesia. 2019;74:663–73.

    Article  CAS  PubMed  Google Scholar 

  9. Zhao J, Han F, Yang Y, Li H, Li Z. Pectoral nerve block in anesthesia for modified radical mastectomy: a meta-analysis based on randomized controlled trials. Medicine (Baltimore). 2019;98:e15423.

    Article  Google Scholar 

  10. Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, et al. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019;72:209–20.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tsui BCH, Fonseca A, Munshey F, McFadyen G, Caruso TJ. The erector spinae plane (ESP) block: a pooled review of 242 cases. J Clin Anesth. 2019;53:29–34.

    Article  PubMed  Google Scholar 

  12. Hong B, Bang S, Chung W, Yoo S, Chung J, Kim S. Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study. Korean J Pain. 2019;32:206–14.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gurkan Y, Aksu C, Kus A, Yorukoglu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: a randomized controlled trial. J Clin Anesth. 2020;59:84–8.

    Article  PubMed  Google Scholar 

  14. Gurkan Y, Aksu C, Kus A, Yorukoglu UH, Kilic CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: a randomized controlled study. J Clin Anesth. 2018;50:65–8.

    Article  PubMed  Google Scholar 

  15. Singh S, Kumar G, Akhileshwar G. Ultrasound-guided erector spinae plane block for postoperative analgesia in modified radical mastectomy: a randomised control study. Indian J Anaesth. 2019;63:200–4.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shim SR, Kim SJ, Lee J, Rucker G. Network meta-analysis: application and practice using R software. Epidemiol Health. 2019;41:e2019013.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee SW, Shim SR, Jeong SY, Kim SJ. Comparison of 5 different PET radiopharmaceuticals for the detection of recurrent medullary thyroid carcinoma: a network meta-analysis. Clin Nucl Med. 2020;45:341–8.

    Article  PubMed  Google Scholar 

  20. Al Ja’bari A, Robertson M, El-Boghdadly K, Albrecht E. A randomised controlled trial of the pectoral nerves-2 (PECS-2) block for radical mastectomy. Anaesthesia. 2019;74:1277–81.

    Article  CAS  PubMed  Google Scholar 

  21. Altiparmak B, Korkmaz Toker M, Uysal AI, Turan M, Gumus DS. Comparison 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. J Clin Anesth. 2019;54:61–5.

    Article  PubMed  Google Scholar 

  22. Bashandy GM, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med. 2015;40:68–74.

    Article  CAS  PubMed  Google Scholar 

  23. Gad M, Abdelwahab K, Abdallah A, Abdelkhalek M, Abdelaziz M. Ultrasound-guided erector spinae plane block compared to modified pectoral plane block for modified radical mastectomy operations. Anesth Essays Res. 2019;13:334–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kim DH, Kim S, Kim CS, Lee S, Lee IG, Kim HJ, et al. Efficacy of pectoral nerve block type II for breast-conserving surgery and sentinel lymph node biopsy: a prospective randomized controlled study. Pain Res Manag. 2018;2018:4315931.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kumar S, Goel D, Sharma SK, Ahmad S, Dwivedi P, Deo N, et al. A randomised controlled study of the post-operative analgesic efficacy of ultrasound-guided pectoral nerve block in the first 24 h after modified radical mastectomy. Indian J Anaesth. 2018;62:436–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Senapathi TGA, Widnyana IMG, Aribawa I, Jaya A, Junaedi IMD. Combined ultrasound-guided Pecs II block and general anesthesia are effective for reducing pain from modified radical mastectomy. J Pain Res. 2019;12:1353–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Sinha C, Kumar A, Kumar A, Prasad C, Singh PK, Priya D. Pectoral nerve versus erector spinae block for breast surgeries: a randomised controlled trial. Indian J Anaesth. 2019;63:617–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Versyck B, van Geffen GJ, Van Houwe P. Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II. J Clin Anesth. 2017;40:46–50.

    Article  CAS  PubMed  Google Scholar 

  29. Wang K, Zhang X, Zhang T, Yue H, Sun S, Zhao H, et al. The efficacy of ultrasound-guided type II pectoral nerve blocks in perioperative pain management for immediate reconstruction after modified radical mastectomy: a prospective, randomized study. Clin J Pain. 2018;34:231–6.

    Article  PubMed  Google Scholar 

  30. Neethu M, Pandey RK, Sharma A, Darlong V, Punj J, Sinha R, et al. Pectoral nerve blocks to improve analgesia after breast cancer surgery: a prospective, randomized and controlled trial. J Clin Anesth. 2018;45:12–7.

    Article  CAS  Google Scholar 

  31. Seelam S, Nair AS, Christopher A, Upputuri O, Naik V, Rayani BK. Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: a randomized controlled study. Saudi J Anaesth. 2020;14:22–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sharma S, Arora S, Jafra A, Singh G. Efficacy of erector spinae plane block for postoperative analgesia in total mastectomy and axillary clearance: a randomized controlled trial. Saudi J Anaesth. 2020;14:186–91.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yao Y, Li H, He Q, Chen T, Wang Y, Zheng X. Efficacy of ultrasound-guided erector spinae plane block on postoperative quality of recovery and analgesia after modified radical mastectomy: randomized controlled trial. Reg Anesth Pain Med. 2019;45:5–9.

    Article  Google Scholar 

  34. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Abdallah FW, MacLean D, Madjdpour C, Cil T, Bhatia A, Brull R. Pectoralis and serratus fascial plane blocks each provide early analgesic benefits following ambulatory breast cancer surgery: a retrospective propensity-matched cohort study. Anesth Analg. 2017;125:294–302.

    Article  PubMed  Google Scholar 

  36. Morioka H, Kamiya Y, Yoshida T, Baba H. Pectoral nerve block combined with general anesthesia for breast cancer surgery: a retrospective comparison. JA Clin Rep. 2015;1:15.

    Article  PubMed  Google Scholar 

  37. Leong RW, Tan ESJ, Wong SN, Tan KH, Liu CW. Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia. 2020;3:404–13.

    Google Scholar 

  38. Porzionato A, Macchi V, Stecco C, Loukas M, Tubbs RS, De Caro R. Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin Anat. 2012;25:559–75.

    Article  PubMed  Google Scholar 

  39. Bremner-Smith AT, Unwin AJ, Williams WW. Sensory pathways in the spinal accessory nerve. J Bone Jt Surg Br. 1999;81:226–8.

    Article  CAS  Google Scholar 

  40. Cros J, Senges P, Kaprelian S, Desroches J, Gagnon C, Labrunie A, et al. Pectoral I block does not improve postoperative analgesia after breast cancer surgery: a randomized, double-blind, dual-centered controlled trial. Reg Anesth Pain Med. 2018;43:596–604.

    Article  PubMed  Google Scholar 

  41. Desroches J, Belliveau M, Bilodeau C, Landry M, Roy M, Beaulieu P. Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes: a prospective volunteer randomized-controlled double-blind study. Can J Anaesth. 2018;65:806–12.

    Article  PubMed  Google Scholar 

  42. Tulgar S, Ahiskalioglu A, De Cassai A, Gurkan Y. Efficacy of bilateral erector spinae plane block in the management of pain: current insights. J Pain Res. 2019;12:2597–613.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Moustafa MA, Kandeel AA. Randomized comparative study between two different techniques of intercostobrachial nerve block together with brachial plexus block during superficialization of arteriovenous fistula. J Anesth. 2018;32:725–30.

    Article  PubMed  Google Scholar 

  44. Aponte A, Sala-Blanch X, Prats-Galino A, Masdeu J, Moreno LA, Sermeus LA. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Can J Anaesth. 2019;66:886–93.

    Article  PubMed  Google Scholar 

  45. Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med. 2018;43:567–71.

    Article  PubMed  Google Scholar 

  46. Choi YJ, Kwon HJ, Jehoon O, Cho TH, Won JY, Yang HM, et al. Influence of injectate volume on paravertebral spread in erector spinae plane block: an endoscopic and anatomical evaluation. PLoS ONE. 2019;14:e0224487.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Reg Anesth Pain Med. 2018;43:756–62.

    PubMed  Google Scholar 

  48. Yang HM, Choi YJ, Kwon HJ, Jehoon O, Cho TH, Kim SH. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia. 2018;73:1244–50.

    Article  CAS  PubMed  Google Scholar 

  49. Schwartzmann A, Peng P, Maciel MA, Forero M. Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study. Can J Anaesth. 2018;65:1165–6.

    Article  PubMed  Google Scholar 

  50. Onishi E, Toda N, Kameyama Y, Yamauchi M. Comparison of clinical efficacy and anatomical investigation between retrolaminar block and erector spinae plane block. Biomed Res Int. 2019;2019:2578396.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research was supported by the National Research Foundation of Korea, NRF-2019R1G1A1099660.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Seyeon Park.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 634 kb)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hong, B., Bang, S., Oh, C. et al. Comparison of PECS II and erector spinae plane block for postoperative analgesia following modified radical mastectomy: Bayesian network meta-analysis using a control group. J Anesth 35, 723–733 (2021). https://doi.org/10.1007/s00540-021-02923-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-021-02923-x

Keywords

Navigation