P O'Scanaill1, S Keane2, V Wall2, G Flood2, D J Buggy3. 1. Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Ireland. Electronic address: padraigoscanaill@gmail.com. 2. Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Ireland. 3. Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Ireland; Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; EU COST Action 15204 Euro-Periscope.
Abstract
BACKGROUND:Pectoral plane blocks (PECs) are increasingly used in analgesia for patients undergoing breast surgery, and were recently found to be at least equivalent to single-shot paravertebral anaesthesia. However, there are no data comparing PECs with the popular practice of continuous local anaesthetic wound infusion (LA infusion) analgesia for breast surgery. Therefore, we compared the efficacy and safety of PECs blocks with LA infusion, or a combination of both in patients undergoing non-ambulatory breast-cancer surgery. METHODS: This single-centre, prospective, randomised, double-blind trial analysed 45 women to receive eitherPECs blocks [levobupivacaine 0.25%, 10 ml PECs I and levobupivacaine 0.25%, 20 ml PECs II (PECs group); LA infusion catheter (levobupivacaine 0.1% at 10 ml h-1 for 24 h (LA infusion group); or both (PECs and LA infusion)]. The primary outcome measure was area under the curve of the pain verbal rating score whilst moving vs time (AUC) over 24 h. Secondary outcomes included total opioid consumption at 24 h. RESULTS: AUC moving was mean (SD) 71 (34) mm h-1vs 58 (41) vs 23 (20) in PECs, LA infusion, and both, respectively; P=0.002. AUC at rest was also significantly lower in patients receiving both. The total 24 h opioid consumption [median (25-75%)] was 14 mg (9-26) vs 11 (8-24) vs 9 (5-11); P=0.4. No adverse events were observed. CONCLUSIONS: The combination of both pre-incisional PECs blocks and postoperative LA infusion provides better analgesia over 24 h than either technique alone after non-ambulatory breast-cancer surgery. CLINICAL TRIAL REGISTRATION: NCT 03024697.
RCT Entities:
BACKGROUND: Pectoral plane blocks (PECs) are increasingly used in analgesia for patients undergoing breast surgery, and were recently found to be at least equivalent to single-shot paravertebral anaesthesia. However, there are no data comparing PECs with the popular practice of continuous local anaesthetic wound infusion (LA infusion) analgesia for breast surgery. Therefore, we compared the efficacy and safety of PECs blocks with LA infusion, or a combination of both in patients undergoing non-ambulatory breast-cancer surgery. METHODS: This single-centre, prospective, randomised, double-blind trial analysed 45 women to receive either PECs blocks [levobupivacaine 0.25%, 10 ml PECs I and levobupivacaine 0.25%, 20 ml PECs II (PECs group); LA infusion catheter (levobupivacaine 0.1% at 10 ml h-1 for 24 h (LA infusion group); or both (PECs and LA infusion)]. The primary outcome measure was area under the curve of the pain verbal rating score whilst moving vs time (AUC) over 24 h. Secondary outcomes included total opioid consumption at 24 h. RESULTS: AUC moving was mean (SD) 71 (34) mm h-1vs 58 (41) vs 23 (20) in PECs, LA infusion, and both, respectively; P=0.002. AUC at rest was also significantly lower in patients receiving both. The total 24 h opioid consumption [median (25-75%)] was 14 mg (9-26) vs 11 (8-24) vs 9 (5-11); P=0.4. No adverse events were observed. CONCLUSIONS: The combination of both pre-incisional PECs blocks and postoperative LA infusion provides better analgesia over 24 h than either technique alone after non-ambulatory breast-cancer surgery. CLINICAL TRIAL REGISTRATION: NCT 03024697.
Authors: Alberto A Uribe; Tristan E Weaver; Marco Echeverria-Villalobos; Luis Periel; Joshua Pasek; Juan Fiorda-Diaz; Marilly Palettas; Roman J Skoracki; Stephen J Poteet; Jarrett A Heard Journal: Front Med (Lausanne) Date: 2022-08-15