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Br J Anaesth. 2016 Sep;117(3):382-6. doi: 10.1093/bja/aew223.

Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial.

Author information

1
Department of Anaesthesia and Intensive Care.
2
Department of Anaesthesia and Intensive Care bhartineerja@yahoo.com.
3
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Abstract

BACKGROUND:

Pectoral nerve (PecS) block is a recently introduced technique for providing surgical anaesthesia and postoperative analgesia during breast surgery. The present study was planned to compare the efficacy and safety of ultrasound-guided PecS II block with thoracic paravertebral block (TPVB) for postoperative analgesia after modified radical mastectomy.

METHODS:

Forty adult female patients undergoing radical mastectomy were randomly allocated into two groups. Group 1 patients received a TPVB with ropivacaine 0.5%, 25 ml, whereas Group 2 patents received a PecS II block using same volume of ropivacaine 0.5% before induction of anaesthesia. Patient-controlled morphine analgesia was used for postoperative pain relief.

RESULTS:

The duration of analgesia was significantly prolonged in patients receiving the PecS II block compared with TPVB [mean (sd), 294.5 (52.76) vs 197.5 (31.35) min in the PecS II and TPVB group, respectively; P<0.0001]. The 24 h morphine consumption was also less in the PecS II block group [mean (sd), 3.90 (0.79) vs 5.30 (0.98) mg in PecS II and TPVB group, respectively; P<0.0001]. Postoperative pain scores were lower in the PecS II group compared with the TVPB group in the initial 2 h after surgery [median (IQR), 2 (2-2.5) vs 4 (3-4) in the Pecs II and TPVB group, respectively; P<0.0001]. Seventeen patients in the PecS II block group had T2 dermatomal spread compared with four patients in the TPVB group (P<0.001). No block-related complication was recorded.

CONCLUSIONS:

We found that the PecS II block provided superior postoperative analgesia than the TPVB in patients undergoing modified radical mastectomy without causing any adverse effect.

CLINICAL TRIAL REGISTRATION:

CTRI/2014/06/004692.

KEYWORDS:

anaesthesia technique, paravertebral block, pectoral nerve block; postoperative analgesia; radical mastectomy

PMID:
27543533
DOI:
10.1093/bja/aew223
[Indexed for MEDLINE]
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