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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.

Wang, Kaiyuan MD; Zhang, Xiaobei MD, PhD; Zhang, Tingting MD; Yue, Hui MD; Sun, Shan MD; Zhao, Hongwei MD, PhD; Zhou, Peng MD
Clinical Journal of Pain: Post Acceptance: June 16, 2017
doi: 10.1097/AJP.0000000000000529
Original Article: PDF Only

Objectives: The pectoral nerves (Pecs) II block is a technique that places local anesthetic between the thoracic muscles to block the axillary and breast regions. This study aimed to compare the quality of perioperative analgesia and side effects of the Pecs II block under general anesthesia versus general anesthesia alone in immediate unilateral breast reconstruction with an implant and latissimus dorsi (LD) flap after modified radical mastectomy.

Methods: Sixty-four patients scheduled for immediate breast reconstruction after modified radical mastectomy were randomly allocated into the Pecs II block under general anesthesia group (Group P, n=32) or the general anesthesia alone group (Group G, n=32). After anesthesia induction, patients in Group P underwent a Pecs II block. The primary end-point was postoperative morphine consumption in the first 24 hours in postoperative intensive care unit (PICU). Intraoperative fentanyl consumption, visual analog scale (VAS) scores, shoulder range of motion and postoperative nausea and vomiting (PONV) were also assessed.

Results: Sixty patients completed the study. There was a significant reduction in postoperative morphine consumption (3.67 mg, 95% CI: 2.91-4.51 mg) and intraoperative fentanyl consumption in Group P patients compared with Group G patients. Less PONV (RR 0.22, 95% CI: 0.05-0.94) and lower VAS scores were also observed in Group P. No block-related complications were recorded.

Discussion: When patients underwent immediate breast reconstruction with an implant and LD flap, the Pecs II block could offer a comprehensive block of associated nerves in the surgical area, and therefore can provide superior analgesia and reduced perioperative opioids use without obvious block-related complications.

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