Pectoral Nerve Block in Multimodal Analgesia for Breast Cancer Surgery

Different types of regional blocks were introduced as good addition to general anesthesia for providing analgesia after breast cancer surgery. The pectoral nerves block (Pecs) is a novel easy superficial technique for peri-operative pain control. The purpose of the study was to investigate the influence of pectoral nerve block to the intraoperative and postoperative opioid consumption in breast cancer surgery. Material and methods. The study included 55 patients, scheduled for elective unilateral modified radical mastectomy or lumpectomy with axillary dissection. Twenty patients received general anesthesia plus pectoral nerve block with 30 ml of 0.375% ropivacaine (Pecs group) and 35 patients with general anesthesia alone (control group, which was form retrospectively from medical histories). Results and discussion. During the first day after operation, the opioid consumption was two times less in the Pecs group than in the control group (0.45±0.51 and 0.97 ±0.82 ml of promedol respectively (p = 0.0335)). Time for first request of promedol was longer in Pecs group – 540.0 (540.0-600.0) than in control group – 145.0 (60.0-420.0). There is no statistically significant difference in intraoperative fentanyl consumption which was observed in both groups. No complications were observed after the block. Although the pectoral blockade was performed prior to surgical intervention, there was no difference in the doses of narcotic analgesics during the operation, which was observed in some other studies. This may be due to the absence of anesthesia of the parenteral region of the skin, which innervates the front branches of the intercostal nerves, which are not covered by the block and require additional anesthesia. As well as the pain of the site of the dermatoses Th 5 and 6, which, as our study showed, the anesthetic is spreading fervently. Conclusions. The pectoral nerve block reduced postoperative opioid consumption in the first 24 hours after breast cancer surgery but didn't influence to intraoperative opioid consumption.