Addition of Transversus Thoracic Muscle Plane Block to Pectoral Nerves Block Provides More Effective Perioperative Pain Relief Than Pectoral Nerves Block Alone for Breast Cancer Surgery

Br J Anaesth. 2017 Mar 1;118(3):439-443. doi: 10.1093/bja/aew449.


Background: The pectoral nerves (PECS) block cannot block the most internal mammary region, whereas a transversus thoracic muscle plane (TTP) block can. The combination of PECS and TTP blocks may be suitable for anterior chest surgery. We studied patients undergoing mastectomy to assess whether the combination of PECS and TTP blocks provides better analgesia than PECS block alone.

Methods: Seventy adult female patients undergoing unilateral mastectomy under general anaesthesia were randomly allocated to receive either the combination of PECS and TTP blocks (PT group, n=35) or the PECS block only (C group, n=35). The primary outcome measure was visual analog scale pain score. Secondary outcomes were the sensory level loss confirmed by cold tests and additional analgesic drugs within 24 h after the operation.

Results: The visual analog scale pain scores were lower in the PT group than the C group. The use of postoperative additional analgesic drugs was also lower lower in the PT group than that in the C group. In the majority of patients in the PT group, sensory loss was confirmed in both the anterior and the lateral branches of thoracic nerves (Th2–6).

Conclusion: Compared with PECS block, the combination of PECS and TTP blocks provides effective perioperative pain relief for breast cancer surgery.

Clinical trial registration: University Hospital Medical Information Network (UMIN) ID number 000018299.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / surgery*
  • Female
  • Humans
  • Mastectomy*
  • Middle Aged
  • Nerve Block / methods*
  • Pain, Postoperative / drug therapy*
  • Perioperative Care / methods*
  • Thoracic Nerves / diagnostic imaging
  • Thoracic Nerves / drug effects*
  • Treatment Outcome
  • Ultrasonography, Interventional / methods