Pectoralis nerves plane block (PECS) first described by Blanco in 2011 has become part of postoperative pain management in breast surgery, thoracic surgery and thoracic trauma. The combination of low complication risk and easiness in mastering of PECS block has made it an interesting alternative to thoracic epidural anesthesia (TEDA) and paravertebral blockade (PVB) for pain treatment after breast surgery. Several studies showed good results when PECS was compared to PVB. PECS blockade however is a procedure requiring some resources in the operating room. An alternative approach is to inject local anesthetics (LA) in the operation field by the surgeon. The hypothesis' tested in this study is primarily: that PECS blockade is superior to LA being injected by surgeon in the operating field measured by end points such as: post-operative pain, post-operative analgesics use, post-operative nausea or vomiting (PONV) and length of stay in the post anesthesia care unit (PACU).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
60
Pectoral nerves block (PECS II) is performed with the help of ultrasound. Two injection are performed in two fascial planes. One between pectoralis major muscle and serratus anterior muscle. Second one between pectoralis major and minor muscles.
Ropivacaine is administered by surgeon prior to scrubbing and following the removal of the tumor.
Ropivacaine is administered by the surgeon at the end of surgery
Local anesthetic ropivacaine is administered in both study arms according to the study protocol
Ultrasound with linear probe is performed. Using in-plane technique a correct placement of the injection needle is secured.
Central Hospital in Karlstad
Karlstad, Värmland County, Sweden
maximal pain in PACU measured with 11 point numerical rating scale (NRS)
NRS scale is a validated for assessment of pain. It is a 11 point scale (0-10) used to estimate severity of postoperative pain. On NRS scale the higher value indicates more severe symptoms.
Time frame: measured at discharge from PACU (on average 4 hours).
Intraoperative fentanyl use
dose of fentanyl used during surgery in milligrams \[mg\].
Time frame: Time is measured from start of the anesthesia until discharge to PACU (on average 3 hours)
Postoperative analgesic use
Postoperative analgesic use is related to pain severity and can be a factor leading to increased length of stay in PACU.
Time frame: measured at 24 hours postoperatively.
Maximal postoperative nausea and vomiting(PONV) in PACU measured with 11 point numerical rating scale (NRS)
PONV NRS similar to pain NRS is an 11 point scale (0-10) used to estimate severity of postoperative nausea. On NRS scale the higher value indicates more severe symptoms.
Time frame: measured at discharge from PACU (on average 4 hours).
Length of stay in PACU
Is an dependant of multiple factors and an important measurement that can indicate beneficial therapeutic choice.
Time frame: on average 4 hours.
Maximal postoperative nausea and vomiting(PONV) after discharge from PACU measured with 11 point numerical rating scale (NRS)
PONV NRS similar to pain NRS is an 11 point scale used to estimate severity of postoperative nausea.
Time frame: 24 hours
Maximal pain after discharge from PACU measured with 11 point numerical rating scale (NRS)
NRS scale is a validated for assessment of pain.
Time frame: 24 hours
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