Intraoperative pectoral nerve block (Pec) for breast cancer surgery: A randomized controlled trial

J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):318-323. doi: 10.4103/joacp.JOACP_191_17.


Background and aims: In centers with high turnover of breast surgeries, pectoral nerve block (Pec II) is time-consuming and requires ultrasound familiarity for administration. We decided to block the same nerves under vision after resection to evaluate postoperative analgesic effects.

Material and methods: Sixty patients scheduled for modified radical mastectomy were enrolled in this prospective, randomized, placebo-controlled, triple-blinded study. All patients received standardized general anesthesia. After surgical resection, infiltration of either ropivacaine (Group A) or saline (Group B) was given under vision at two points: 20 ml in the fascia over serratus anterior and 10 ml in the fascia between pectoralis major and minor at the level of the third rib. The primary outcomes measured were the time to first request for analgesia after extubation and total dose of analgesics needed, and secondary outcome included pain scores using the Numerical Rating Scale over 24 h. Analgesics used postoperatively were fentanyl citrate and paracetamol. We used Student's t-test to analyze quantity of analgesics needed, the nonparametric Mann-Whitney U-test for time to first request of analgesic, and Fisher's exact test for pain scores.

Results: No patient in Group A required fentanyl. The mean time to first request for analgesia and mean dose of paracetamol required was 353.93 ± 135.03 min and 2.71 ± 0.462.71 g in Group A and 27.17 ± 18.08 min and 3.53 ± 1.074 g in Group B [P = 0.002]. Significantly more patients in Group A had mild pain scores compared to Group B.

Conclusion: Pec II block with ropivacaine delivered under vision reduced analgesic requirement and pain scores significantly.

Keywords: Breast neoplasm; modified radical mastectomy; nerve block; postoperative pain; ropivacaine.