Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial

Autor: Patrick Senges, Nathalie Nathan, Suzan Kaprelian, Pierre Beaulieu, Benoît Marin, Julie Desroches, Caroline Gagnon, Sabrina Crepin, Jérôme Cros, Anaïs Labrunie
Přispěvatelé: Department of Anesthesiology and Pharmacology, CHU Montréal, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Service de l'Information Médicale et de l'Évaluation [CHU Limoges] (SIME), CHU Limoges, Laboratoire de Biostatistique et d'Informatique Médicale, Université de Limoges (UNILIM), Service de Pharmacologie, toxicologie et pharmacovigilance [CHU Limoges]
Rok vydání: 2018
Předmět:
medicine.medical_specialty
Breast surgery
medicine.medical_treatment
MESH: Mastectomy
Analgesic
Breast Neoplasms
Placebo
law.invention
Sufentanil
03 medical and health sciences
0302 clinical medicine
Breast cancer
Randomized controlled trial
Double-Blind Method
030202 anesthesiology
law
medicine
MESH: Thoracic Nerves
Humans
MESH: Double-Blind Method
030212 general & internal medicine
MESH: Pain
Postoperative
Mastectomy
Aged
Bupivacaine
MESH: Aged
Pain
Postoperative
MESH: Humans
MESH: Middle Aged
Thoracic Nerves
business.industry
MESH: Autonomic Nerve Block
General Medicine
Middle Aged
medicine.disease
3. Good health
Surgery
Anesthesiology and Pain Medicine
MESH: Analgesia
Nerve block
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Female
Analgesia
business
MESH: Female
MESH: Breast Neoplasms
medicine.drug
Autonomic Nerve Block
Zdroj: Regional Anesthesia and Pain Medicine
Regional Anesthesia and Pain Medicine, Lippincott, Williams & Wilkins, 2018, 43 (6), pp.596-604. ⟨10.1097/AAP.0000000000000779⟩
ISSN: 1532-8651
1098-7339
Popis: Background and Objectives General anesthesia for breast surgery may be supplemented by using a regional anesthetic technique. We evaluated the efficacy of the first pectoral nerve block (Pecs I) in treating postoperative pain after breast cancer surgery. Methods A randomized, double-blind, dual-centered, placebo-controlled trial was performed. One hundred twenty-eight patients scheduled for unilateral breast cancer surgery were recruited. A multimodal analgesic regimen and surgeon-administered local anesthetic infiltration were used for all patients. Ultrasound-guided Pecs I was performed using bupivacaine or saline. The primary outcome was the patient pain score (numerical rating scale [NRS]) in the recovery unit 30 minutes after admission or just before the morphine administration (NRS ≥4/10). The secondary outcomes were postoperative opioid consumption (ie, in the recovery unit and after 24 hours). Results During recovery, no significant difference in NRS was observed between the bupivacaine (n = 62, 3.0 [1.0–4.0]) and placebo (n = 65, 3.0 [1.0–5.0]) groups (P = 0.55). However, the NRS was statistically significantly different, although not clinically significant, for patients undergoing major surgeries (mastectomies or tumorectomies with axillary clearance) (n = 29, 3.0 [0.0–4.0] vs 4.0 [2.0–5.0], P = 0.04). Morphine consumption during recovery did not differ (1.5 mg [0.0–6.0 mg] vs 3.0 mg [0.0–6.0 mg], P = 0.20), except in the major surgery subgroup (1.5 mg [0.0–6.0 mg] vs 6.0 mg [0.0–12.0 mg], P = 0.016). Intraoperative sufentanil and cumulative morphine consumption up to 24 hours did not differ between the 2 groups. Three patients experienced complications related to the Pecs I. Conclusions Pecs I is not better than a saline placebo in the presence of multimodal analgesia for breast cancer surgery. However, its role in extended (major) breast surgery may warrant further investigation. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT01670448.
Databáze: OpenAIRE
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