Pectoral nerve blocks to improve analgesia after breast cancer surgery: A prospective, randomized and controlled trial

Study objective To evaluate the analgesic efficacy of ultrasound guided combined pectoral nerve blocks I and II in patients scheduled for surgery for breast cancer. Design Prospective, randomized, control trial. Setting Operating rooms in a tertiary care hospital of Northern India. Patients Sixty American Society of Anesthesiologists status I to II adult women, aged 18–70 years were enrolled in this study. Interventions Patients were randomized into two groups (30 patients in each group), PECS (P) group and control (C) group. In group P, patients received both general anesthesia and ultrasound guided combined pectoral nerve blocks (PECS I and II). In group C, patients received only general anesthesia. Measurements We noted pain intensity at rest and during abduction of the ipsilateral upper limb, incidence of postoperative nausea and vomiting; patient's satisfaction with postoperative analgesia and maximal painless abduction at different time intervals in both groups. Main results There was significant decrease in the total amount of fentanyl requirement in the in P group {(140.66 ± 31.80 μg) and (438 ± 71.74 μg)} in comparison to C group {(218.33 ± 23.93 μg) and (609 ± 53.00 μg)} during intraoperative and post-operative period upto 24 h respectively. The time to first analgesic requirement was also more in P group (44.33 ± 17.65 min) in comparison to C group (10.36 ± 4.97 min) during post-operative period. There was less limitation of shoulder movement (pain free mobilization) on the operative site at 4 h and 5 h after surgery in P group in comparison to C group. However there was no difference in the incidence of post-operative nausea and vomiting (22 out of 30 patients in group P and 20 out of 30 patients in group C) but patients in group P had a better satisfaction score with postoperative analgesia than C group having a p value of < 0.001(Score 1; 5 VS 20; Score 2; 12 VS 9; Score 3; 13 VS 1). Conclusions Ultrasound guided combined pectoral nerve blocks are an effective modality of analgesia for patients undergoing breast surgeries during perioperative period. Clinical trial registration: CTRI/2015/12/006457