Abstract

Background and Aims: Women recovering from breast cancer operations frequently report intense early pain, and inadequately controlled acute pain of this kind is known to predispose to a persistent postsurgical pain syndrome. Deposition of local anaesthetic within the pectoral fascial planes, described as the modified pectoral nerve (Pecs I and II) technique, has been advanced as a means of relieving pain after breast procedures that incorporate clearance of the axillary nodes. Our aim was to determine how well this ultrasound directed block controls pain in the first postoperative day, and to document its influence on circulatory variables and on the occurrence of adverse events. Methods: Sixty women of ASA physical status I or II, between 25 and 65 years of age and listed for breast surgery that included axillary clearance, were enrolled in this double blind, randomised, prospective comparison. One arm (Group A, n = 30) received a standard general anaesthetic without any regional supplementation, while the other (Group B, n = 30) received the same general anaesthetic together with an ultrasound directed modified Pecs block using 30 ml of bupivacaine 0.25 percent. How long and how effectively pain was controlled, graded on a visual analogue scale (VAS), served as the principal endpoint. Circulatory endpoints (mean arterial pressure and heart rate during and after operation), the need for supplementary analgesics, the level of sedation and any complications across 24 hours were recorded as additional outcomes. Results: At every recording point through the first 24 hours, pain scores were lower in the block arm than in the control arm (p less than 0.05). Fifteen minutes after operation, a pain score of zero was reported by 43.3 percent of the women who had received the block, whereas no control patient was pain free at that time. Far fewer patients in the block arm asked for supplementary analgesia (6.66 percent against 36.7 percent; p = 0.030). Mean arterial pressure, both during and after surgery, was lower in the block arm at the majority of time points, whereas differences in heart rate seldom reached significance. There were no complications attributable to the block, and sedation levels did not differ between the arms. Conclusion: When added to general anaesthesia for breast surgery that includes axillary clearance, the ultrasound directed modified Pecs block delivers good pain relief and lowers the demand for additional analgesics. It is therefore a worthwhile element of a multimodal analgesic plan for these patients.

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