Georges Assaf Linda Gholmieh Rony Al Nawwar Sandra Nassif Jenyfer Daoud Yara Ghabour Walid Maroun Hanane Barakat

Keywords: Nausea, PECS I block, PECS II block, Postoperative morphine, Pain, Postoperative, Regional anesthesia, Ultrasound, Vomiting, Postoperative

Abstract

Background & objective: Perioperative management of female patients undergoing breast surgery includes a big anesthetic task to adequately manage persistent postoperative pain and postoperative nausea and vomiting (PONV). Pectoral nerve blocks (PECS I and PECS II), while effective in managing postoperative pain, carry a risk of throacoacromial artery puncture with the lateral approach. We evaluated analgesic efficacy of medial approach to PECS I and PECS II blocks in female patients undergoing breast surgery under general anesthesia (GA).

Methodology: This is a retrospective study of 116 female patients undergoing modified radical mastectomy that were divided into two groups. Group 1 patients received PECS block with general anesthesia and Group 2 patients received general anesthesia alone. Mean time to extubate, postoperative morphine consumption and PONV were evaluated up to 24 h.

Results: Patients who received the PECS block required significantly less postoperative morphine immediately after and 12 h after surgery (P = 0.043 and P = 0.006, respectively). There was no significant difference in PONV between both groups in the first 24 h (P > 0.05). Time to extubation (TTE) was significantly less in Group 1 patients (P < 0.001).

Conclusion: The medial approach of PECS I and II nerve block is effective and safe demonstrating reduced postoperative morphine requirement.

Abbreviations: PECS: Pectoral Nerve Blocks; PONV:  Postoperative Nausea and Vomiting; TPVB: thoracic paravertebral block; TTE: Time to Extubation;

Keywords: Nausea; PECS I block; PECS II block; Postoperative morphine; Pain, Postoperative; Regional anesthesia; Ultrasound; Vomiting, Postoperative

Citation: Assaf G, Gholmieh L, Al Nawwar R, Nassif S, Daoud J, Ghabour Y, Maroun W, Barakat H. Effectiveness of the medial approach to PECS block in modified radical mastectomy: a retrospective study. Anaesth. pain intensive care 2024;28(2):237−242; DOI: 10.35975/apic.v28i2.2426

Received: January 18, 2024; Revised: February 06, 2024; Accepted: February 28, 2024