PECS II block is associated with lower incidence of chronic pain after breast surgery
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Background: Breast cancer is complicated by a high incidence of chronic postoperative pain (25%-60%). Regional anesthesia might play an important role in lowering the incidence of chronic pain; however it is not known if the pectoral nerve block (PECS block), which is commonly used for breast surgery, is able to prevent this complication. Our main objective was therefore to detect any association between the PECS block and chronic pain at 3, 6, 9, and 12 months in patients undergoing breast surgery. Methods: We conducted a prospective, monocentric, observational study. We enrolled 140 consecutive patients undergoing breast surgery and divided them in patients receiving a PECS block and general anesthesia (PECS group) and patients receiving only general anesthesia (GA group). Then we considered both intraoperative variables (intravenous opioids administration), postoperative data (pain suffered by the patients during the first 24 postoperative hours and the need for additional analgesic administration) and development and persistence of chronic pain (at 3, 6, 9, and 12 mo). Results: The PECS group had a lower incidence of chronic pain at 3 months (14.9% vs. 31.8%, P = 0.039), needed less intraoperative opioids (fentanyl 1.61 μg/kg/hr vs. 3.3 μg/kg/hr, P < 0.001) and had less postoperative pain (3 vs. 4, P = 0.017). Conclusions: The PECS block might play an important role in lowering incidence of chronic pain, but further studies are needed.
Abstract
Background: Breast cancer is complicated by a high incidence of chronic postoperative pain (25%-60%). Regional anesthesia might play an important role in lowering the incidence of chronic pain; however it is not known if the pectoral nerve block (PECS block), which is commonly used for breast surgery, is able to prevent this complication. Our main objective was therefore to detect any association between the PECS block and chronic pain at 3, 6, 9, and 12 months in patients undergoing breast surgery. Methods: We conducted a prospective, monocentric, observational study. We enrolled 140 consecutive patients undergoing breast surgery and divided them in patients receiving a PECS block and general anesthesia (PECS group) and patients receiving only general anesthesia (GA group). Then we considered both intraoperative variables (intravenous opioids administration), postoperative data (pain suffered by the patients during the first 24 postoperative hours and the need for additional analgesic administration) and development and persistence of chronic pain (at 3, 6, 9, and 12 mo). Results: The PECS group had a lower incidence of chronic pain at 3 months (14.9% vs. 31.8%, P = 0.039), needed less intraoperative opioids (fentanyl 1.61 μg/kg/hr vs. 3.3 μg/kg/hr, P < 0.001) and had less postoperative pain (3 vs. 4, P = 0.017). Conclusions: The PECS block might play an important role in lowering incidence of chronic pain, but further studies are needed.
참고문헌 (16)
- "Estimated number of new cases in 2018, worldwide, both sexes, all ages"[URL]
- Andersen KG, "Persistent pain after breast cancer treatment : a critical review of risk factors and strategies for prevention", J Pain, 12, pp.725~746 (2011)
- Peuckmann V, "Chronic pain and other sequelae in long-term breast cancer survivors : nationwide survey in Denmark", Eur J Pain, 13, pp.478~485 (2009)
- Blyth FM, "Chronic pain-related disability and use of analgesia and health services in a Sydney community", Med J Aust, 179, pp.84~87 (2003)
- Blanco R, "Ultrasound description of Pecs II(modified Pecs I) : a novel approach to breast surgery", Rev Esp Anestesiol Reanim, 59, pp.470~475 (2012)
- Versyck B, "A qualitative systematic review of the pectoral nerves block type I and II", Acta Anaesthesiol Belg, 68, pp.49~62 (2017)
- Treede RD, "A classification of chronic pain for ICD-11", Pain, 156, pp.1003~1007 (2015)
- Gärtner R, "Prevalence of and factors associated with persistent pain following breast cancer surgery", JAMA, 302, pp.1985~1992 (2009)
- Des Jarlais DC, "Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions : the TREND statement", Am J Public Health, 94, pp.361~366 (2004)
- Weinstein EJ, "Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children", Cochrane Database Syst Rev, 6, pp.CD007105~ (2018)
- Tasmuth T, "Treatment-related factors predisposing to chronic pain in patients with breast cancer--a multivariate approach", Acta Oncol, 36, pp.625~630 (1997)
- Kraychete DC, "Postoperative persistent chronic pain : what do we know about prevention, risk factors, and treatment", Braz J Anesthesiol, 66, pp.505~512 (2016)
- Albi-Feldzer A, "A double-blind randomized trial of wound and intercostal space infiltration with ropivacaine during breast cancer surgery : effects on chronic postoperative pain", Anesthesiology, 118, pp.318~326 (2013)
- Cros J, "Pectoral I block does not improve postoperative analgesia after breast cancer surgery : a randomized, double-blind, dual-centered controlled trial", Reg Anesth Pain Med, 43, pp.596~604 (2018)
- Bashandy GM, "Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery : a randomized clinical trial", Reg Anesth Pain Med, 40, pp.68~74 (2015)
- Yu EH, "Remifentanil tolerance and hyperalgesia : short-term gain, long-term pain", Anaesthesia, 71, pp.1347~1362 (2016)