Intercostal nerve block versus bupivacaine pectoralis major infiltration in subpectoral breastaugmentation : a randomized controlled trial

Background : The purpose of our study is to evaluate the role of intercostal nerve block and pectoralis major muscle infiltration in postoperative pain management following subpectoral breast augmentation. Methods : This is a prospective randomized controlled study using patients as their own controls. Women undergoing primary bilateral subpectoral breast augmentation from July 2012 until July 2013 were enrolled and randomly allocated to two cohorts. Both cohorts received pectoralis major muscle infiltration using 20 mL of 0.25% bupivacaine with epinephrine on one breast. The contralateral breast was treated with intercostal nerve block in cohort 1, and with a placebo infiltration of the pectoralis major muscle in cohort 2. The 10-point Visual Analog Scale was used postoperatively on each breast at 0, 1, 3, 8 and 24 hours at rest and after movement. The change in pain score difference over time was analyzed with a mixed effect linear regression model. Results : Cohort 1 and 2 consisted of 13 and 15 patients respectively. Pectoralis major muscle infiltration and intercostal nerve block were easily performed and no complications were reported. When comparing pectoralis major muscle infiltration to intercostal nerve block, there was no difference in pain on admission to the recovery room at rest (p = 0.98), or after movement (p = 0.79). Postoperative pain gradually decreased with time and no difference in pain was found across time at rest (p = 0.91), or on movement (p = 0.92). The comparison of pectoralis major muscle infiltration to placebo yielded similar results with no difference in pain on admission or across time. Conclusion : Intercostal nerve block and pectoralis major muscle infiltration do not offer any significant analgesic benefit following breast augmentation.- Contexte : Le but de cette étude est d’évaluer le rôle du bloc nerveux intercostal et de l’infiltration du muscle grand pectoral dans la prise en charge de la douleur après augmentation mammaire rétromusculaire. Méthodes : C’est une étude prospective randomisée contrôlée sur des patientes qui sont aussi leurs propres témoins. Les patientes opérées entre juillet 2012 et juillet 2013 d’une augmentation mammaire primaire rétromusculaire ont été randomisées et divisées en deux groupes. Toutes les patientes ont reçu sur un des deux côtés une infiltration du muscle grand pectoral par 20 ml de bupivacaïne 0,25% avec de l'épinéphrine. Du côté controlatéral, un bloc nerveux intercostal a été prati