Details
Category: Volume 10 Issue 03 March 2022
Hits: 677

Title: Comparison of Ultrasound Guided Modified Pectoral Nerve Block 2 versus Erector Spinae Plane Block For Post Operative Pain Relief in Patients Undergoing Modified Radical Mastectomy

Authors: Dr Amutha Rani R, Dr Ahila K, Dr Pavithr A S

 DOI: https://dx.doi.org/10.18535/jmscr/v10i3.26

Abstract

Background: Breast carcinoma is most common malignancy among female patients. Pain is the most common symptom encountered during post operative period after MRM. Peripheral nerve block is the emerging procedure in anaesthesiology and modified pectoral nerve block 2 and erector spinae plane blocks are given for post operative pain relief in patients undergoing MRM without any side effects.

Aim and Objectives: To compare the effect of modified pectoral nerve block 2 and erector spinae plane block in patients undergoing MRM for post operative pain relief.

Methodology: It is a prospective randomized comparative study conducted in 64 patients undergoing MRM in tirunelveli medical college and hospital. Age group includes 18-65 years of female sex who have given informed written consent. Preanaesthetic evaluation done, checked for iv acess, all monitors connected, hemodynamics before the procedure were noted. Group 1 received modified pectoral nerve block 2 with 0.2% ropivacaine 25ml and group 2 received erector spinae plane block with 0.2% ropivacaine 20ml. pain score after the procedure noted by using VAS score[0-10].

Results: PEC 2 Group recorded a better VAS Recovery score than the ESP Group (mean: 2.5 versus 3.65). Opioid requirment is lower in PEC 2 Group compared to ESP group.

Conclusion: Ultrasound guided regional anaesthesia is playing a major role in terms of providing the patients better post operative care. Modified pectoral nerve block 2 is safe and effective procedure during breast cancer surgeries especially modified radical mastectomy. It shows lower intraop and postoperative opioid consumption than erector spinae plane block.

References

  1. Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: A meta-analysis of randomized controlled trials. Br J Anaesth. 2010;105:842–52.
  2. Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): Anovel approach to breast surgery. Ref Esp Anestesiol Reanim. 2012;59:470–5.
  3. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621–7.
  4. Bashandy GM, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: A randomized clinical trial. Reg Anesth Pain Med. 2015;40:68–74.
  5. Khemka R, Chakrborty A, Agrawal S, Ahmed R. Is COMBIPECS the answer to perioperative analgesia for breast surgery? A double blinded randomized controlled trial. Indian J Anaesth. 2019;63:530–6.
  6. Altiparmak B, Korkmaz Toker M, Uysal Aİ, Turan M, Gümüş Demirbilek Comparison of the effects of modified pectoral nerve block and erector spinae block on postoperative opioid consumption and pian scores ofpatients after radical mastectomy surgery: A prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61–5
  7. Kwekkeboom K. Postmastectomy pain syndromes. Cancer Nurs. 1996;19:37–43.
  8. Vecht CJ, van de Brand HJ, Wajer OJ. Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve. Pain. 1989;38:171–6.
  9. Wahba SS, Kamal SM. Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery. Egypt J Anaesth. 2014;30:129–35
  10. Bakshi SG, Karan N, Parmar V. Pectoralis block for breast surgery: A surgical concern? Indian J Anaesth. 2017;61:851–2.
  11. Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: A randomized controlled trial. Br J Anaesth. 2016;117:382–6
  12. Gürkan Y, Aksu C, Kusş A, Yörükogğlu UH, Kılıç CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randopmized controlled study.
  13. Singh S, Kumar G, Akhileshwar Ultrasound-guided erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomised control study. Indian J Anaesth. 2019;63:200–20.
  14. Wijayasinghe N, Andersen KG, Kehlet H. Analgesic and sensory effects of the pecs local anesthetic block in patients with persistent pain after breast cancer surgery: A pilot study. Pain Pract. 2017;17:185–91.
  15. Efficacy and Safety of Pectoral Nerve Block (Pecs) Compared With Control, Paravertebral Block, Erector Spinae Plane Block, and Local Anesthesia in Patients Undergoing Breast Cancer Surgeries A Systematic Review and Meta-analysis Elshanbary, Alaa Ahmed MBBCh*
  16. Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery a report of 3 cases. Reg Anesth Pain Med. 2017;42(3):372–376. doi: 10.1097/AAP.0000000000000581.
  17. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology.
  18. P. Kline, “Ultrasound guidance in anesthesia,” AANA Journal, vol. 79, no. 3, pp. 209–217, 2011.
  19. R. Falyar, “Ultrasound in anesthesia: applying scientific principles to clinical practice,” AANA Journal, vol. 78, no. 4, pp. 332–340,
  20. Hatfield and A. Bodenham, “Ultrasound: an emerging role in anaesthesia and intensive care,” British Journal of Anaesthesia, vol. 83, no. 5, pp. 789–800, 1999.
  21. S. Kristensen, “Ultrasonography in the management of the airway,” Acta Anaesthesiologica Scandinavica, vol. 55, no. 10, pp. 1155–1173, 2011.
  22. Stefanidis, S. Dimopoulos, and S. Nanas, “Basic principles and current applications of lung ultrasonography in the intensive care unit,” Respirology, vol. 16, no. 2, pp. 249–256, 2011.S. Kaddoura, Echo Made Easy, Elsevier, 2009.
  23. J. Koscielniak-Nielsen, “Ultrasound-guided peripheral nerve blocks: what are the benefits?” Acta Anaesthesiologica Scandinavica, vol. 52, no. 6, pp. 727–737, 2008.J. Griffin and B. Nicholls, “Ultrasound in regional anaesthesia,” Anaesthesia, vol. 65, supplement 1,
  24. S. Liu, J. Ngeow, and R. S. John, “Evidence basis for ultrasound- guided block characteristics: onset, quality, and duration,” Regional Anesthesia and Pain Medicine, vol. 35, no. 2, pp. S26–S35, 2010.
  25. Ivani and V. Mossetti, “Pediatric regional anesthesia,” Minerva Anestesiologica, vol. 75, no. 10, pp. 577–583, 2009.
  26. Rubin, D. Sullivan, and S. Sadhasivam, “Are peripheral and neuraxial blocks with ultrasound guidance more effective and safe in  children?” Paediatric Anaesthesia, vol. 19, no. 2, pp. 92–96, 2009.

Corresponding Author

Dr Amutha Rani R MD

Prof & HOD, Department of Anaesthesiology, Tirunelveli Medical College