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Master Thesis

Pectoral nerve blocks (PEC I and II) for breast augmentation surgery: a randomized, double-blind, dual-centered controlled trial

Abstract : Background: pectoral nerves blocks (PECS) have been proposed for analgesia during and after breast cancer surgery but data are conflicted in aesthetic breast surgery. We tested the primary hypothesis that adding pre-incisional PECS is superior to systemic multimodal analgesic regimen alone for pain control after breast augmentation surgery. A second hypothesis is that we could decrease rescue opioid consumption with a long-lasting effect for both outcomes during the following days. Methods: seventy-three adult female patients undergoing aesthetic breast augmentation surgery under general anesthesia were randomly allocated to receive PECS versus no block. Both groups received standard care with protocolized multimodal analgesia alone including systematic acetaminophen and NSAIDs. The primary outcome measure was the maximal NRS in the first six hours after extubation. Secondary outcomes included intraoperative remifentanil consumption, and from extubation to day 5: maximal NRS, postoperative cumulative opioid consumption and postoperative opioid side effects, and patient satisfaction recorded at day 5. Results: maximal NRS score in the first six hours was lower in the PECS group compared with the control group [3.9 ± 2.5 vs 5.2 ± 2.2; difference: -1.2 (95%CI: -2.3 to -0.1), p=0.036]. PECS group had a lower maximal NRS between Day 1 and Day 5 [2.2 ± 1.9 vs 3.2 ± 1.7; p=0.032]. Cumulative amount of overall opioids consumption (oral morphine equivalent) was lower for PECS group from the 6th hour to Day 1 (0.0 [0.0 to 21.0] vs 21.0 [0.0 to 31.5] mg, p=0.006) and from Day 1 to 5 (0.0 [0.0 to 21.0] vs 21.0 [0.0 to 51] mg, p=0.002). Conclusions: PECS block in conjunction with multimodal analgesia provides effective perioperative pain relief after aesthetic breast surgery, and is associated with reduced opioid consumption over the first 5 postoperative days.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03341323
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Submitted on : Friday, September 10, 2021 - 4:23:54 PM
Last modification on : Wednesday, October 13, 2021 - 3:31:26 AM

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Thomas Odonnat. Pectoral nerve blocks (PEC I and II) for breast augmentation surgery: a randomized, double-blind, dual-centered controlled trial. Human health and pathology. 2021. ⟨dumas-03341323⟩

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