Analgesic Effect of Adding Thoracic Paravertebral Nerve Blocks to Modified PEC Block in Breast Cancer Surgery

Mahidol University100 enrolled

Overview

To compare efficacy and safety of adding thoracic paravertebral nerve blocks to modified PEC block versus modified PEC block only in breast cancer surgery. This study evaluate systemic opioid requirement in 48 hours in primary outcome and the analgesic profile ( pain score at rest and on shoulder movement), opioid-related side effects and nerve blocks complications.

Regional anesthesia has been used and studied extensively in breast surgery as an opioid-sparing strategy, with block of the intercostal supply by thoracic paravertebral block (TPVB) becoming a popular technique. This prospective randomized controlled trial is aimed to study the proper regional nerve block technique to reach the postoperative opioid-free requirement modality for breast cancer surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

100

Conditions

Breast Cancer Female Pain, Postoperative

Interventions

Thoracic paravertebral block under ultrasound guidancePROCEDURE

Ultrasound-guided thoracic paravertebral blocks in T2, T4 level

Intraoperative modified PEC blockPROCEDURE

Pectoral nerve block by surgeon under direct vision after total mastectomy

GA with ETTPROCEDURE

General anesthesia with endotracheal intubation

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * American Society of Anesthesiologists (ASA) grade I-III * Aged ≥ 18-80 years old * Elective unilateral total mastectomy with sentinel lymph node biopsy or lymph node dissection Exclusion Criteria: * Patient refusal * Language barrier or inability to communicate with the operating team * Allergy to local anesthetic * Bleeding disorder * Previous breast surgery or thoracic radiation therapy * BMI ≥ 30 * Patient who can not understand the proper use of intravenous patient-controlled analgesia machine or who has the problem with communication * Chronic pain patient

Locations (1)

Faculty of Medicine Siriraj Hospital, Mahidol University

Bangkok Noi, Bangkok, Thailand

RECRUITING

Outcomes

Primary Outcomes

Postoperative fentanyl consumption

Cumulative fentanyl consumption within postoperative 24 hours

Time frame: at postoperative 24 hours

Postoperative fentanyl consumption

Cumulative fentanyl consumption within postoperative 24-48 hours

Time frame: at postoperative 48 hours