Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery

Abstract

AbstractBackgroundPectoral nerve block (Pecs) is a novel interfascial plane block which can provide analgesia after breast surgery while paravertebral block (PVB) is widely used for this purpose. We evaluated the difference between the two techniques in regard to morphine consumption and analgesic efficacy after modified radical mastectomy (MRM).MethodsSixty patients undergoing elective MRM were randomly allocated into either PVB with 15–20ml of levobupivacaine 0.25% at the level of fourth thoracic vertebra or Pecs block with 10ml of levobupivacaine 0.25% injected inbetween pectoralis major and pectoralis minor muscle and another 20ml levobubivacaine 0.25% inbetween pectorlis minor and serratus anterior muscle. Primary outcome measure was morphine consumption in the first 24h while secondary outcome measures included pain scores, intraoperative fentanyl consumption as well as postoperative nausea and vomiting (PONV).ResultsPostoperative morphine consumed at 24h was significantly lower in Pecs group [21 (20–25) mg] than in PVB group [28 (22–31) mg], (p=0.002). Time for first request of morphine was longer in Pecs group [175 (155–220) min] than in PVB group [137.5 (115–165) min], (p<0.001). Numerical rating score (NRS) at rest was lower in Pecs group compared with PVB group at 1h, 6h and 12h (p<0.001) but at 18h and 24h it was lower in PVB group compared with Pecs group (p=0.008 and <0.001 respectively). During movement, NRS was significantly lower at 1st hour in Pecs group (p<0.001) while at 18h and 24h it was significantly lower in PVB group (p<0.001). PONV was comparable between both groups.ConclusionPecs block reduced postoperative morphine consumption in the first 24 and pain scores in the first 12h in comparison with PVB after mastectomy