Interpectoral-pectoserratus plane (PECS II) block in patients undergoing trans-axillary thoracic outlet decompression surgery; A prospective double-blind, randomized, placebo-controlled clinical trial.

Autor: van den Broek RJC; Department of Anesthesiology and Pain medicine, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands; Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands. Electronic address: Renee.vd.broek@catharinaziekenhuis.nl., Goeteyn J; Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Vascular Surgery, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands. Electronic address: Jens.goeteyn@catharinaziekenhuis.nl., Houterman S; Department of Education and Research, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands. Electronic address: Saskia.houterman@catharinaziekenhuis.nl., Bouwman RA; Department of Anesthesiology and Pain medicine, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 19, 5612 AP Eindhoven, the Netherlands. Electronic address: Arthur.bouwman@catharinaziekenhuis.nl., Versyck BJB; Department of Anesthesiology and Pain medicine, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands; Department of Anesthesiology and Pain Medicine, AZ Turnhout, Steenweg op Merksplas 44, 2300 Turnhout, Belgium. Electronic address: Barbara.versyck@azturnhout.be., Teijink JAW; Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Vascular Surgery, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands. Electronic address: Joep.Teijink@catharinaziekenhuis.nl.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2022 Nov; Vol. 82, pp. 110939. Date of Electronic Publication: 2022 Jul 27.
DOI: 10.1016/j.jclinane.2022.110939
Abstrakt: Study Objective: To investigate if an interpectoral-pectoserratus plane (PECS II) block decreases postoperative pain, postoperative nausea and vomiting and improves quality of recovery in patients with neurogenic thoracic outlet syndrome (NTOS) undergoing trans-axillary thoracic outlet decompression surgery.
Design: A prospective single center double blinded randomized placebo-controlled trial.
Setting: Perioperative period; operating room, post anesthesia care unit (PACU) and hospital ward.
Patients: Seventy patients with NTOS, undergoing trans-axillary thoracic outlet decompression surgery.
Interventions: Patients were randomized to an interventional arm, receiving the block with 40 ml ropivacaine 0.5% (concentration was adjusted if the patient's weight was <66 kg), and a placebo group, receiving a sham block with 40 ml NaCl 0.9%. The interpectoral-pectoserratus plane block was performed ultrasound guided; the first injection below the pectoral minor muscle and the second below the pectoral major muscle. The hospitals' pharmacist prepared the study medication and was the only person able to see the randomization result. The study was blinded for patients, researchers and medical personnel.
Measurements: Primary outcome parameters were postoperative pain, measured by numeric rating scale on the PACU (start and end) and on the ward on postoperative day (POD) 0 and 1, and postoperative morphine consumption, measured on the PACU and on the ward during the first 24 h. Secondary outcome parameters were postoperative nausea and vomiting, and quality of recovery.
Main Results: There was no statistically significant difference in NRS on the PACU at the start (ropivacaine 4.9 ± 3.2 vs placebo 6.2 ± 3.0, p = .07), at the end (ropivacaine 4.0 ± 1.7 vs placebo 3.9 ± 1.7, p = .77), on the ward on POD 0 (ropivacaine 4.6 ± 2.0 vs placebo 4.6 ± 2.0, p = 1.00) or POD 1 (ropivacaine 3.9 ± 1.8 vs placebo 3.6 ± 2.0, p = .53). There was no difference in postoperative morphine consumption at the PACU (ropivacaine 11.0 mg ± 6.5 vs placebo 10.8 mg ± 4.8, p = .91) or on the ward (ropivacaine 11.6 mg ± 8.5 vs placebo 9.6 mg ± 9.4, p = .39).
Conclusions: The interpectoral-pectoserratus plane block is not effective for postoperative analgesia in patients with NTOS undergoing trans-axillary thoracic outlet decompression surgery.
Competing Interests: Declaration of Competing Interest Dr. R.A. Bouwman is a clinical consultant for Philips Research (Eindhoven, the Netherlands) since January 2016. The other authors declare no potential conflict of interest.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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