Effectiveness of Pectoral Nerve Blocks (PEC II) for Post Operative Pain Management in Breast Surgery

Abstract

Background: Breast surgery is one of the most performed surgeries in Bangladesh. Though there is growing interest in using regional anaesthesia in other surgeries, the use of regional anaesthesia modalities for postoperative pain management in breast surgery is still lacking. Post operative pain in breast surgery is moderate to severe and there is increased incidence of postoperative persistent pain. In this study, the effectiveness of pectoral nerve blocks (PECs II) was assessed in comparison to no regional anaesthesia and overall impact was identified in breast surgery.
Methods: This randomized controlled study was conducted from January 2022 to December 2022. Total 60 female adult patients undergoing elective unilateral modified radical mastectomy under general anesthesia were allocated in two groups. 30 patients received PEC II block with general anaesthesia and other 30 patients only received general anaesthesia. All patients received pre-emptive analgesia oral Paracetamol (1g) 1 hour before surgery and Inj. Diclofenac (75 mg) at induction. Postoperative analgesia with numerical pain rating score (NPRS), perioperative haemodynamic status with mean arterial pressure (MAP), perioperative blood loss, timing of first dose of supplemental analgesic requirement, total Morphine consumption, incidence of persistent postsurgical pain were assessed.
Results: In postoperative period mean NPRS was 2.0 (± 0.3) in PECs group compared to 4.6 (± 0.9) for control group for first 24 hours. Mean timing of first dose of Morphine requirement in PECs group was 8.2 (± 0.3) hours compared with 30.5 (± 2.8) minutes after arrival in PACU for control group. Morphine consumption in 24 hours was 7.3 (± 2.1) mg for PECs group and 18.5 (± 9.5) mg in control group. Average MAP was 66.3 (± 7.4) for PECs group and 81.4 (± 4.9) for no block group in first 24 hours after surgery. Mean intraoperative blood loss in PECs group was 91.67 (± 0.5) ml and in control 215 (± 2.7) ml. Surgeon satisfaction was 71% in PECs group regarding the perioperative blood loss. The incidence of persistent postsurgical pain was 13.33% in control group with no incidence in PECs group.
Conclusion: PEC II block provides an effective postoperative analgesia as part of multimodal analgesic techniques. It is also associated with positive effect on perioperative stable haemodynamic. To prevent chronic pain, PEC II block seems to be effective.