Comparison of Analgesic Efficacy of Pectoralis Type II Block (PECS-II) Versus Erector Spinae Block (ESP) After Modified Radical Mastectomy

Mirza Hamid  Beg; Osama Abdul  Mateen; Taimur Azam  Khan; Shahzada  Irfan; Khalid  Buland; Junaid  Zafar

doi:10.51253/pafmj.v76i5.10373

Authors

Mirza Hamid Beg Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Osama Abdul Mateen Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Taimur Azam Khan Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Shahzada Irfan Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Khalid Buland Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Junaid Zafar Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i5.10373

Keywords:

Analgesia, Breast Cancer, Erector Spinae Block, Modified Radical Mastectomy, Pectoralis Type II Block

Abstract

Objective: To compare the post-operative analgesic efficacy of ultrasound-guided pectoralis type II (PECS II) block versus erector spinae (ESP) block in patients undergoing modified radical mastectomy (MRM) for breast cancer.

Study Design: Prospective observational study

Place and Duration of Study: Anesthesia Department of Combined Military Hospital, Rawalpindi, Pakistan, from Jun to Dec 2022.

Methodology: The patients were divided into the pectoralis type II block (Group PECS II) (n=25) and erector spinae block group (Group ESP) (n=25). Primary variables measured were mean time to first rescue analgesia, mean dose of nalbuphine required for control of pain in the next 24 hours, and mean HDU stay. Secondary parameters observed were patient satisfaction on the Likert scale 24 hours after the procedure and incidence of complications between both groups.

Results: Time to first rescue analgesia was longer in the PECS-II group at 355.84±12.64 minutes versus 242.32±10.83 minutes in the ESP group (p<0.001). Subsequently, the total analgesia requirement was also considerably decreased in the PECS-II group with 4.64±0.63 mg in 24 hours versus 8.08±0.90 mg in 24 hours in the ESP group (p<0.001). Mean HDU stay was also statistically significant and was less in the PECS-II versus ESP group, with a mean stay of 27.40±2.21 hours versus 30.60±5.14 hours (p=0.002).

Conclusion: The PECS-II block provides superior analgesia with a favorable adverse effect profile, providing excellent pain relief and patient satisfaction.

Downloads

Download data is not yet available.

References

1. Fregoso G, Wang A, Tseng K, Wang J. Transition from acute to chronic pain: evaluating risk for chronic postsurgical pain. Pain Physician 2019;22(5):479-488.

2. Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet 2019;393(10180):1537-1546.

https://doi.org/10.1016/S0140-6736(19)30033-1

3. Marshall K, McLaughlin K. Pain management in thoracic surgery. Thorac Surg Clin 2020;30(3):339-346.

https://doi.org/10.1016/j.thorsurg.2020.03.001

4. Chandrakar N, Shinde RK. Study of the early complications of modified radical mastectomy performed. Int Surg J 2019;6(1):239-243.

https://doi.org/10.18203/2349-2902.isj20185483

5. Ali H, Muhammad S, Balouch V, Shaikh M, Kumari P. Incidence of primary complications afterwards modified radical mastectomy in breast cancer. Pak J Med Health Sci 2022;16(02):1218-1220.

https://doi.org/10.53350/pjmhs221621218

6. Kashyap D, Pal D, Sharma R, Garg VK, Goel N, Koundal D, et al. Global increase in breast cancer incidence: risk factors and preventive measures. BioMed Res Int 2022;2022:9605439.

https://doi.org/10.1155/2022/9605439

7. Lei S, Zheng R, Zhang S, Wang S, Chen R, Sun K, et al. Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Commun 2021;41(11):1183-1194.

https://doi.org/10.1002/cac2.12207

8. Giacalone A, Alessandria P, Ruberti E. The physiotherapy intervention for shoulder pain in patients treated for breast cancer: Systematic review. Cureus 2019;11(12):e6426.

https://doi.org/10.7759/cureus.6426

9. Asaoka M, Gandhi S, Ishikawa T, Takabe K. Neoadjuvant chemotherapy for breast cancer: past, present, and future. Breast Cancer 2020;14:1178223420980377.

https://doi.org/10.1177/1178223420980377

10. Dinges HC, Otto S, Stay DK, Bäumlein S, Waldmann S, Kranke P, et al. Side effect rates of opioids in equianalgesic doses via intravenous patient-controlled analgesia: a systematic review and network meta-analysis. Anesth Analg 2019;129(4):1153-1162.

https://doi.org/10.1213/ANE.0000000000003887

11. Bakeer A, Abdallah NM. Erector Spinae Plane Block Versus PECS Block Type II for Breast Surgery: A Randomized Controlled Trial. Anesth Pain Med 2022;12(2):e124031. https://doi.org/10.5812/aapm-124031

12. Versyck B, van Geffen GJ, Chin KJ. Analgesic efficacy of the Pecs II block: a systematic review and meta-analysis. Anaesthesia 2019;74(5):663-673.

https://doi.org/10.1111/anae.14607

13. Darswal P, Arora D. Out-of-plane approach to erector spinae plane block. Anaesth Pain Intensive Care 2020;24(3):366-367.

https://doi.org/10.35975/apic.v24i3.1293

14. Singh S, Kumar G. Ultrasound-guided erector spinae plane block for postoperative analgesia in modified radical mastectomy: a randomised controlled study. Indian J Anaesth 2019;63(3):200-204.

https://doi.org/10.4103/ija.IJA_727_18

15. Helander EM, Webb MP, Kendrick J, Montet T, Kaye AJ, Cornett EM, et al. PECS, serratus plane, erector spinae, and paravertebral blocks: A comprehensive review. Best Pract Res Clin Anaesthesiol 2019;33(4):573-581.

https://doi.org/10.1016/j.bpa.2019.07.003

16. Taketa Y, Irisawa Y, Fujitani T. Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial. Reg Anesth Pain Med 2020;45(1):10-15.

https://doi.org/10.1136/rapm-2019-100821

17. Nielsen MV, Moriggl B, Hoermann R, Nielsen TD, Bendtsen TF, Børglum J. Are single-injection erector spinae plane block and multiple-injection costotransverse block equivalent to thoracic paravertebral block? Acta Anaesthesiol Scand 2019;63(9):1231-1238.

https://doi.org/10.1111/aas.13424

18. Elshanbary AA, Zaazouee MS, Darwish YB, Omran MJ, Elkilany AY, Abdo MS, et al. 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. Clin J Pain 2021;37(12):925-939.

https://doi.org/10.1097/AJP.0000000000000988

19. Senapathi TGA, Widnyana IMG, Aribawa IGNM, Jaya AGPS, Junaedi IMD. Combined ultrasound-guided Pecs II block and general anesthesia are effective for reducing pain from modified radical mastectomy. J Pain Res 2019;12:1353-1358.

https://doi.org/10.2147/JPR.S197484

20. Magoon R, Kaushal B, Chauhan S, Bhoi D, Bisoi AK, Khan MA. A randomised controlled comparison of serratus anterior plane, pectoral nerves and intercostal nerve block for post-thoracotomy analgesia in adult cardiac surgery. Indian J Anaesth 2020;64(12):1018-1024.

https://doi.org/10.4103/ija.IJA_834_20

21. Jinn CK, Kariem EB. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review. Can J Anesth 2021;68(3):387-408.

https://doi.org/10.1007/s12630-020-01875-y

22. Mehdiratta L, Bajwa SJS, Malhotra N, Joshi M. Exploring cocktails, remixes and innovations in regional nerve blocks: The clinical research journey continues. Indian J Anaesth 2020;64(12):1003-1006.

https://doi.org/10.4103/ija.IJA_1517_20