Efficacy of the pectoral nerve block type II and paravertebral block for enhanced recovery after breast cancer surgery


  • V.V. Martsiniv Feofaniya Clinical Hospital of State Management of Affairs, Kyiv, Ukraine; Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine, Ukraine




thoracic paravertebral block, pectoral nerve block, breast surgery


Background. Breast cancer surgery is associated with severe postoperative pain and increased frequency of postope­rative nausea and vomiting (PONV). It slows down patients’ mobilization in the postoperative period. Regional anesthesia provides better analgesia and can be part of enhanced recovery after surgery. The purpose of this study is to compare the efficacy of the pectoral nerve block type II, paravertebral block, and systemic analgesia concerning the opioids consumption, PONV, time to first food intake, and mobilization of patients in the perioperative period of breast cancer surgery. Materials and methods. Ninety-one adult women after unilateral radical mastectomy or quadrantectomy with axillary dissection were enrolled and randomized into three groups depending on the type of anesthesia. The control group included only patients with general ane­sthesia (GA), pectoral block group — GA plus pectoral nerve block type II with ropivacaine 0.375% 30 ml, and paravertebral block (PVB) group — GA plus thoracic paravertebral block with ropivacaine 0.5% 20 ml. The evaluated variables included ­opioids consumption during and after surgery, the occurrence of PONV, the time to the first feeding, and first mobilization in the postoperative period. Results. The dose of fentanyl during the operation was 2.6 (2.07‑3.62) μg/kg/h in the control group, 2.3 (1.86‑2.94) μg/kg/h in the PB group, 1.9 (1.62‑2.24) μg/kg/h in the PVB group (p = 0.003). Nine patients (31 %) in the control group, 8 patients (27 %) in the PVB group, and 6 patients (19 %) in the PB group required analgesia with promedol 2% after surgery (p = 0.542). The time to getting out of bed in the control, PB and PVB groups was 360 (150–360) min, 170 (120–240) min, and 162.5 (120–240) min, respectively (p = 0.003), and the time to the first meal was 360 (240–360) min, 165 (120–240) min, and 180 (120–220) min, respectively (p < 0.001). The incidence of PONV was the lowest in the PB group — 6 vs. 27 vs. 31 % in the PVB and control groups, respectively (p = 0.027). Conclusions. Among studied methods of analgesia in breast cancer surgery, the pectoral nerve block type II has the greatest advantages for enhanced recovery after surgery.


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