The Effectiveness of PECS II Block on PONV and Rescue Opioid Dose in Post–Modified Radical Mastectomy Patients

Waldemar P Siahaan, Barry Imanuel Kambey, Garry Dietmar Chrysogonus Kumaat, Venesa Laurent Ngantung

Abstract

Background: Modified radical mastectomy (MRM) remains a mainstay for breast cancer but is associated with significant postoperative pain and postoperative nausea and vomiting (PONV). Pectoralis II (PECS II) block offers targeted chest wall analgesia with potential opioid‐sparing and antiemetic benefits.

Methods: This single‐blind randomized trial included 32 women (30–65 years) undergoing MRM were allocated to general anesthesia (GA; n=16) or GA combined with ultrasound‐guided PECS II block (GA+PECS; n=16). Primary outcome was the mean numeric rating scale (NRS) score in the first 24 hours. Secondary outcomes included incidence of PONV and need for rescue opioid. Sample size was calculated to detect a 2‐point NRS difference (SD 2, α=0.05, β=0.20).

Results: Mean NRS was significantly lower in GA+PECS (1.38 ± 0.50) versus GA alone (3.44 ± 1.37, p< 0.001). PONV occurred in 5/16 (31.3%) of GA patients and 0/16 (0%) of GA+PECS patients (p-value = 0.02). Rescue opioid was required in 1/16 (6.3%) of GA patients versus none in GA+PECS (p-value = 0.31).

Conclusion: Adding PECS II block to GA in MRM substantially improves postoperative pain control and eliminates PONV, with minimal opioid rescue. Larger multicenter studies are warranted to confirm these findings.

Keywords

Mastectomy; Opioid; PECS Block; PONV

Full Text:

PDF

References

Lukasiewicz S, Czeczelewski M, et al. Breast Cancer–Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies–An Updated Review. Cancers 2021;13(17):4287.

Kummerow KL, Du L, et al. Nationwide Trends in Mastectomy for Early-Stage Breast Cancer. JAMA Surg 2015;150(1):9–16.

Patey D, Dyson W. The prognosis of carcinoma of the breast in relation to the type of operation performed. Br J Cancer 1948;2:7–13.

Aubrun F, Ecoffey C, et al. Perioperative pain and post-operative nausea and vomiting (PONV) management after day-case surgery: The SFAR-OPERA national study. Anaesth Crit Care Pain Med 2019;38(3):223–229.

Blanco R. The ‘pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia 2011;66(9):847–848.

Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim 2012;59(9):470–475.

Battista C, Krishnan S. Pectoralis Nerve Block. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.

Hussain N, Brull R, McCartney CJL, et al. Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery: A Systematic Review and Meta-analysis. Anesthesiology 2019;131(3):630–648.

Kulhari S, Bharti N, et al. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth 2016;117(3):382–386.

Dixon JM, Thomas J, et al. A study of margin width and local recurrence in breast conserving therapy for invasive breast cancer. Eur J Surg Oncol 2016;42(5):657–664.

Smith HS, Laufer A. Opioid induced nausea and vomiting. Eur J Pharmacol 2014;722:67–78.

Rosyadi I, Anam K, Mochamat M. A PECS II Block as Post Operative Analgesia After Modified Radical Mastectomy. Solo J Anesthesi Pain Crit Care 2024;4(2):–.

DOI: https://doi.org/10.20961/soja.v6i1.112962

Refbacks

  • There are currently no refbacks.