The Analgesic Efficacy of Pecto-Intercostal Fascial Block Combined with Pectoral Nerve Block in Modified Radical Mastectomy: A Prospective Randomized Trial
Pectoral nerve (Pecs) block is one of the most promising regional analgesic techniques for breast surgery. However, Pecs II block may not provide analgesia of the medial aspect of the breast or the entire nipple-areolar complex. The aim of the present study was to investigate the efficacy of combini...
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| Veröffentlicht in: | Pain physician 2020-09, Vol.23 (5), p.485-493 |
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| description | Pectoral nerve (Pecs) block is one of the most promising regional analgesic techniques for breast surgery. However, Pecs II block may not provide analgesia of the medial aspect of the breast or the entire nipple-areolar complex.
The aim of the present study was to investigate the efficacy of combining the pecto-intercostal fascial block (PIFB) and Pecs II block for perioperative analgesia following modified radical mastectomy (MRM).
A prospective randomized study.
An academic medical center.
Sixty women undergoing unilateral MRM were randomly divided into 2 groups. The Pecs II group received Pecs II block using 20 mL bupivacaine 0.25% between the serratus anterior and the external intercostal muscles, and 10 mL bupivacaine 0.25% between the pectoralis major and minor muscles, together with sham PIFB using 15 mL normal saline solution in the interfascial plane between the pectoralis major muscle and the external intercostal muscle. PIFB-Pecs II group received the same Pecs II block combined with PIFB using 15 mL bupivacaine 0.25%.
The median (interquartile range [IQR]) time to the first morphine dose was significantly longer in the PIFB-Pecs II group (327.5 [266.3-360.0] minutes) than the Pecs II group (196 [163.8-248.8] minutes) (P < 0.001, 95% confidence interval [CI] 79.98, 150.00).The median (IQR) cumulative morphine consumption was higher in the Pecs II group (14.0 [11.0-18.0] mg) than the PIFB-Pecs II group (8.0 [7.0-9.0] mg) (P < 0.001; CI, 4.0-8.0). Intraoperative consumption of fentanyl was significantly lower in PIFB-Pecs II group with a median (IQR) of 0 (0-15 mu g) than the Pecs II group median 57.5 (0-75 mu g) (P = 0.022, CI; 0-60). The Visual Analog Scale scores for the first 12 postoperative hours were lower in the PIFB-Pecs II group than the Pecs II group at rest and on moving the ipsilateral arm (P < 0.001). The dermatomal block on the lateral chest wall was comparable between the 2 studied groups. PIFB-Pecs II provided extensive sensory block on the anterior chest wall, whereas Pecs II block failed to achieve any sensory block.
This study was limited by its small sample size.
The combination of Pecs II and PIFB provide better perioperative analgesia for MRM than Pecs II alone. |
| doi_str_mv | 10.36076/PPj.2020.23.485 |
| format | Article |
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The aim of the present study was to investigate the efficacy of combining the pecto-intercostal fascial block (PIFB) and Pecs II block for perioperative analgesia following modified radical mastectomy (MRM).
A prospective randomized study.
An academic medical center.
Sixty women undergoing unilateral MRM were randomly divided into 2 groups. The Pecs II group received Pecs II block using 20 mL bupivacaine 0.25% between the serratus anterior and the external intercostal muscles, and 10 mL bupivacaine 0.25% between the pectoralis major and minor muscles, together with sham PIFB using 15 mL normal saline solution in the interfascial plane between the pectoralis major muscle and the external intercostal muscle. PIFB-Pecs II group received the same Pecs II block combined with PIFB using 15 mL bupivacaine 0.25%.
The median (interquartile range [IQR]) time to the first morphine dose was significantly longer in the PIFB-Pecs II group (327.5 [266.3-360.0] minutes) than the Pecs II group (196 [163.8-248.8] minutes) (P < 0.001, 95% confidence interval [CI] 79.98, 150.00).The median (IQR) cumulative morphine consumption was higher in the Pecs II group (14.0 [11.0-18.0] mg) than the PIFB-Pecs II group (8.0 [7.0-9.0] mg) (P < 0.001; CI, 4.0-8.0). Intraoperative consumption of fentanyl was significantly lower in PIFB-Pecs II group with a median (IQR) of 0 (0-15 mu g) than the Pecs II group median 57.5 (0-75 mu g) (P = 0.022, CI; 0-60). The Visual Analog Scale scores for the first 12 postoperative hours were lower in the PIFB-Pecs II group than the Pecs II group at rest and on moving the ipsilateral arm (P < 0.001). The dermatomal block on the lateral chest wall was comparable between the 2 studied groups. PIFB-Pecs II provided extensive sensory block on the anterior chest wall, whereas Pecs II block failed to achieve any sensory block.
This study was limited by its small sample size.
The combination of Pecs II and PIFB provide better perioperative analgesia for MRM than Pecs II alone.</description><identifier>ISSN: 1533-3159</identifier><identifier>EISSN: 2150-1149</identifier><identifier>DOI: 10.36076/PPj.2020.23.485</identifier><identifier>PMID: 32967391</identifier><language>eng</language><publisher>United States: American Society of Interventional Pain Physician</publisher><subject>Analgesics ; Breast Neoplasms - surgery ; Breast surgery ; Female ; Humans ; Intercostal Nerves ; Mastectomy ; Mastectomy, Modified Radical - adverse effects ; Middle Aged ; Morphine ; Nerve Block - methods ; Pain management ; Pain Management - methods ; Pain, Postoperative - etiology ; Pain, Postoperative - prevention & control ; Prospective Studies ; Thoracic Nerves ; Ultrasonography, Interventional - methods</subject><ispartof>Pain physician, 2020-09, Vol.23 (5), p.485-493</ispartof><rights>2020. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32967391$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abu Elyazed, Mohamed M</creatorcontrib><creatorcontrib>Abdelghany, Mohamed S</creatorcontrib><creatorcontrib>Mostafa, Shaimaa F</creatorcontrib><title>The Analgesic Efficacy of Pecto-Intercostal Fascial Block Combined with Pectoral Nerve Block in Modified Radical Mastectomy: A Prospective Randomized Trial</title><title>Pain physician</title><addtitle>Pain Physician</addtitle><description>Pectoral nerve (Pecs) block is one of the most promising regional analgesic techniques for breast surgery. However, Pecs II block may not provide analgesia of the medial aspect of the breast or the entire nipple-areolar complex.
The aim of the present study was to investigate the efficacy of combining the pecto-intercostal fascial block (PIFB) and Pecs II block for perioperative analgesia following modified radical mastectomy (MRM).
A prospective randomized study.
An academic medical center.
Sixty women undergoing unilateral MRM were randomly divided into 2 groups. The Pecs II group received Pecs II block using 20 mL bupivacaine 0.25% between the serratus anterior and the external intercostal muscles, and 10 mL bupivacaine 0.25% between the pectoralis major and minor muscles, together with sham PIFB using 15 mL normal saline solution in the interfascial plane between the pectoralis major muscle and the external intercostal muscle. PIFB-Pecs II group received the same Pecs II block combined with PIFB using 15 mL bupivacaine 0.25%.
The median (interquartile range [IQR]) time to the first morphine dose was significantly longer in the PIFB-Pecs II group (327.5 [266.3-360.0] minutes) than the Pecs II group (196 [163.8-248.8] minutes) (P < 0.001, 95% confidence interval [CI] 79.98, 150.00).The median (IQR) cumulative morphine consumption was higher in the Pecs II group (14.0 [11.0-18.0] mg) than the PIFB-Pecs II group (8.0 [7.0-9.0] mg) (P < 0.001; CI, 4.0-8.0). Intraoperative consumption of fentanyl was significantly lower in PIFB-Pecs II group with a median (IQR) of 0 (0-15 mu g) than the Pecs II group median 57.5 (0-75 mu g) (P = 0.022, CI; 0-60). The Visual Analog Scale scores for the first 12 postoperative hours were lower in the PIFB-Pecs II group than the Pecs II group at rest and on moving the ipsilateral arm (P < 0.001). The dermatomal block on the lateral chest wall was comparable between the 2 studied groups. PIFB-Pecs II provided extensive sensory block on the anterior chest wall, whereas Pecs II block failed to achieve any sensory block.
This study was limited by its small sample size.
The combination of Pecs II and PIFB provide better perioperative analgesia for MRM than Pecs II alone.</description><subject>Analgesics</subject><subject>Breast Neoplasms - surgery</subject><subject>Breast surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Intercostal Nerves</subject><subject>Mastectomy</subject><subject>Mastectomy, Modified Radical - adverse effects</subject><subject>Middle Aged</subject><subject>Morphine</subject><subject>Nerve Block - methods</subject><subject>Pain management</subject><subject>Pain Management - methods</subject><subject>Pain, Postoperative - etiology</subject><subject>Pain, Postoperative - prevention & control</subject><subject>Prospective Studies</subject><subject>Thoracic Nerves</subject><subject>Ultrasonography, Interventional - methods</subject><issn>1533-3159</issn><issn>2150-1149</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkU9vEzEQxS0EoqFw54QsceGywX_W3jW3ELVQqYWoCmfL8Y6pw-46tTeg8FX4skxJ4MBpNDO_9yzPI-QlZ3OpWaPfrlbbuWCCzYWc1616RGaCK1ZxXpvHZMaVlJXkypyRZ6VsGZPaGPmUnElhdCMNn5Ff6zugi9H1X6FETy9CiN75A02BrsBPqboaJ8g-lcn19NIVH7G-75P_Rpdp2MQROvojTndHOuPyE-TvcELiSG9SF0NE6tZ1aN3TG1emB3Y4vKMLusqp7LCNqLl1Y5eG-BPhdcZ3npMnwfUFXpzqOflyebFefqyuP3-4Wi6uKy-FmCqQQTUBOjAQJHCulOObDlrX-Fq3MnCnceJbMDiVWradcI0IjtVeYO_lOXlz9N3ldL-HMtkhFg9970ZI-2JFXSvTCNUIRF__h27TPuP5kNJKMyZqViPFjpTH35UMwe5yHFw-WM7sn-AsBmcfgrNCWgwOJa9OxvvNAN0_wd-k5G930ZWM</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Abu Elyazed, Mohamed M</creator><creator>Abdelghany, Mohamed S</creator><creator>Mostafa, Shaimaa F</creator><general>American Society of Interventional Pain Physician</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20200901</creationdate><title>The Analgesic Efficacy of Pecto-Intercostal Fascial Block Combined with Pectoral Nerve Block in Modified Radical Mastectomy: A Prospective Randomized Trial</title><author>Abu Elyazed, Mohamed M ; Abdelghany, Mohamed S ; Mostafa, Shaimaa F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c322t-e3f57fede9ef3e1155a1bde8a7c4683f1a65a1c8e9bde3638d2a72fa04c2e36c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Analgesics</topic><topic>Breast Neoplasms - surgery</topic><topic>Breast surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Intercostal Nerves</topic><topic>Mastectomy</topic><topic>Mastectomy, Modified Radical - adverse effects</topic><topic>Middle Aged</topic><topic>Morphine</topic><topic>Nerve Block - methods</topic><topic>Pain management</topic><topic>Pain Management - methods</topic><topic>Pain, Postoperative - etiology</topic><topic>Pain, Postoperative - prevention & control</topic><topic>Prospective Studies</topic><topic>Thoracic Nerves</topic><topic>Ultrasonography, Interventional - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abu Elyazed, Mohamed M</creatorcontrib><creatorcontrib>Abdelghany, Mohamed S</creatorcontrib><creatorcontrib>Mostafa, Shaimaa F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pain physician</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abu Elyazed, Mohamed M</au><au>Abdelghany, Mohamed S</au><au>Mostafa, Shaimaa F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Analgesic Efficacy of Pecto-Intercostal Fascial Block Combined with Pectoral Nerve Block in Modified Radical Mastectomy: A Prospective Randomized Trial</atitle><jtitle>Pain physician</jtitle><addtitle>Pain Physician</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>23</volume><issue>5</issue><spage>485</spage><epage>493</epage><pages>485-493</pages><issn>1533-3159</issn><eissn>2150-1149</eissn><abstract>Pectoral nerve (Pecs) block is one of the most promising regional analgesic techniques for breast surgery. However, Pecs II block may not provide analgesia of the medial aspect of the breast or the entire nipple-areolar complex.
The aim of the present study was to investigate the efficacy of combining the pecto-intercostal fascial block (PIFB) and Pecs II block for perioperative analgesia following modified radical mastectomy (MRM).
A prospective randomized study.
An academic medical center.
Sixty women undergoing unilateral MRM were randomly divided into 2 groups. The Pecs II group received Pecs II block using 20 mL bupivacaine 0.25% between the serratus anterior and the external intercostal muscles, and 10 mL bupivacaine 0.25% between the pectoralis major and minor muscles, together with sham PIFB using 15 mL normal saline solution in the interfascial plane between the pectoralis major muscle and the external intercostal muscle. PIFB-Pecs II group received the same Pecs II block combined with PIFB using 15 mL bupivacaine 0.25%.
The median (interquartile range [IQR]) time to the first morphine dose was significantly longer in the PIFB-Pecs II group (327.5 [266.3-360.0] minutes) than the Pecs II group (196 [163.8-248.8] minutes) (P < 0.001, 95% confidence interval [CI] 79.98, 150.00).The median (IQR) cumulative morphine consumption was higher in the Pecs II group (14.0 [11.0-18.0] mg) than the PIFB-Pecs II group (8.0 [7.0-9.0] mg) (P < 0.001; CI, 4.0-8.0). Intraoperative consumption of fentanyl was significantly lower in PIFB-Pecs II group with a median (IQR) of 0 (0-15 mu g) than the Pecs II group median 57.5 (0-75 mu g) (P = 0.022, CI; 0-60). The Visual Analog Scale scores for the first 12 postoperative hours were lower in the PIFB-Pecs II group than the Pecs II group at rest and on moving the ipsilateral arm (P < 0.001). The dermatomal block on the lateral chest wall was comparable between the 2 studied groups. PIFB-Pecs II provided extensive sensory block on the anterior chest wall, whereas Pecs II block failed to achieve any sensory block.
This study was limited by its small sample size.
The combination of Pecs II and PIFB provide better perioperative analgesia for MRM than Pecs II alone.</abstract><cop>United States</cop><pub>American Society of Interventional Pain Physician</pub><pmid>32967391</pmid><doi>10.36076/PPj.2020.23.485</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Analgesics Breast Neoplasms - surgery Breast surgery Female Humans Intercostal Nerves Mastectomy Mastectomy, Modified Radical - adverse effects Middle Aged Morphine Nerve Block - methods Pain management Pain Management - methods Pain, Postoperative - etiology Pain, Postoperative - prevention & control Prospective Studies Thoracic Nerves Ultrasonography, Interventional - methods |
| title | The Analgesic Efficacy of Pecto-Intercostal Fascial Block Combined with Pectoral Nerve Block in Modified Radical Mastectomy: A Prospective Randomized Trial |
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