scholarly journals Efficacy of pectoral nerve block type II versus thoracic paravertebral block for analgesia in breast cancer surgery

2020 ◽  
Vol 33 (4) ◽  
pp. 296-301
Author(s):  
Volodymyr Martsiniv ◽  
Oleg Loskutov ◽  
Andriy Strokan ◽  
Maksim Pylypenko ◽  
Mihailo Bondar
Keyword(s):  
Breast Cancer ◽  
Nerve Block ◽  
Cancer Surgery ◽  
Paravertebral Block ◽  
Breast Cancer Surgery ◽  
Block Type ◽  
Type Ii ◽  
Thoracic Paravertebral Block ◽  
Pectoral Nerve

scholarly journals EFFICACY OF PECTORAL NERVE BLOCK TYPE II VERSUS THORACIC PARAVERTEBRAL BLOCK FOR ANALGESIA IN BREAST CANCER SURGERY

2020 ◽  
Vol 73 (7) ◽  
pp. 1470-1475
Author(s):  
Volodymyr V. Martsiniv ◽  
Oleg A. Loskutov ◽  
Andriy M. Strokan ◽  
Mihaylo V. Bondar
Keyword(s):  
Breast Cancer ◽  
Nerve Block ◽  
Cancer Surgery ◽  
Paravertebral Block ◽  
Breast Cancer Surgery ◽  
Block Type ◽  
Type Ii ◽  
Thoracic Paravertebral Block ◽  
Pectoral Nerve ◽  
Block Groups

The aim: to compare the efficacy of pectoral nerve block type II and thoracic paravertebral block for analgesia during and after breast cancer surgery. Materials and methods: Sixty adult women were undergoing unilateral radical mastectomy or quadrantectomy with axillary dissection. Patients were randomized to receive either pectoral nerve block with ropivacaine 0.375% 30 ml or thoracic paravertebral block with ropivacaine 0.5% 20 ml. Evaluated variables included pain intensity at 0, 2, 4, 6, 12, 18 and 24 hours, intraoperative fentanyl, 24-hour postoperative opioid (promedol) and nonopioid (ketoprofen) consumption, the time to first rescue analgesia. Results: There were no statistically significant differences between pectoral block and paravertebral block groups in intraoperative fentanyl consumption 2,2 (1,81-2,81) vs 1,9 (1,63-2,25) mcg/kg/hour (Р>0,05) and in the pain intensity during the first 24 hours after operation. The mean postoperative 24-hour promedol and ketoprofen consumption was 4,0 (±8,14) mg vs 5,0 (±8,85) mg (Р>0,05) and 66,7 (±66,09) mg vs 95,8 (±90,78) mg (Р>0,05) in the pectoral and paravertebral block groups respectively. Time to the first analgesia request was longer in pectoral block group — 540 (455,0-600,0) min vs 515 (265,0-650,0) min (Р>0,05). There were no complications after pectoral blocks and 2 complications after paravertebral blocks. Conclusions: in breast cancer surgery pectoral nerve block type II can provide postoperative analgesia comparable to thoracic paravertebral block with lower complications rate.

scholarly journals Efficacy of the pectoral nerve block type II and paravertebral block for enhanced recovery after breast cancer surgery

2021 ◽  
Vol 17 (4) ◽  
pp. 43-50
Author(s):  
V.V. Martsiniv
Keyword(s):  
Breast Cancer ◽  
Nerve Block ◽  
Enhanced Recovery ◽  
Cancer Surgery ◽  
Paravertebral Block ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Block Type ◽  
Type Ii ◽  
Pectoral Nerve

Background. Breast cancer surgery is associated with severe postoperative pain and increased frequency of postope­rative nausea and vomiting (PONV). It slows down patients’ mobilization in the postoperative period. Regional anesthesia provides better analgesia and can be part of enhanced recovery after surgery. The purpose of this study is to compare the efficacy of the pectoral nerve block type II, paravertebral block, and systemic analgesia concerning the opioids consumption, PONV, time to first food intake, and mobilization of patients in the perioperative period of breast cancer surgery. Materials and methods. Ninety-one adult women after unilateral radical mastectomy or quadrantectomy with axillary dissection were enrolled and randomized into three groups depending on the type of anesthesia. The control group included only patients with general ane­sthesia (GA), pectoral block group — GA plus pectoral nerve block type II with ropivacaine 0.375% 30 ml, and paravertebral block (PVB) group — GA plus thoracic paravertebral block with ropivacaine 0.5% 20 ml. The evaluated variables included ­opioids consumption during and after surgery, the occurrence of PONV, the time to the first feeding, and first mobilization in the postoperative period. Results. The dose of fentanyl during the operation was 2.6 (2.07‑3.62) μg/kg/h in the control group, 2.3 (1.86‑2.94) μg/kg/h in the PB group, 1.9 (1.62‑2.24) μg/kg/h in the PVB group (p = 0.003). Nine patients (31 %) in the control group, 8 patients (27 %) in the PVB group, and 6 patients (19 %) in the PB group required analgesia with promedol 2% after surgery (p = 0.542). The time to getting out of bed in the control, PB and PVB groups was 360 (150–360) min, 170 (120–240) min, and 162.5 (120–240) min, respectively (p = 0.003), and the time to the first meal was 360 (240–360) min, 165 (120–240) min, and 180 (120–220) min, respectively (p < 0.001). The incidence of PONV was the lowest in the PB group — 6 vs. 27 vs. 31 % in the PVB and control groups, respectively (p = 0.027). Conclusions. Among studied methods of analgesia in breast cancer surgery, the pectoral nerve block type II has the greatest advantages for enhanced recovery after surgery.

scholarly journals COMPARISON OF C-REACTIVE PROTEIN, CORTISOL AND INTERLEUKIN-6 DYNAMICS AFTER BREAST SURGERY UNDER GENERAL ANESTHESIA, OR GENERAL ANESTHESIA IN COMBINATION WITH PECTORAL BLOCK, OR GENERAL ANESTHESIA IN COMBINATION WITH THORACIC PARAVERTEBRAL BLOCK

2021 ◽  
pp. 103-110
Author(s):  
V. V. Martsiniv
Keyword(s):  
Breast Cancer ◽  
Stress Response ◽  
General Anesthesia ◽  
Nerve Block ◽  
Surgical Stress ◽  
Paravertebral Block ◽  
Block Type ◽  
Surgical Stress Response ◽  
Thoracic Paravertebral Block ◽  
Pectoral Nerve

Modern anesthesiologic coverage and support has its one of the main goals to decrease a surgical stress response of the patient after surgery. It is very important especially in cancer patients. Breast cancer is the most frequently diagnosed malignancy among women in Ukraine. The thoracic paravertebral block is widely used for analgesia of breast surgery by decades. In recent years, novel miofascial blocks, such of them ultrasound-guided pectoral nerve block type II, have become a very popular anesthesiologic technique in addition to general anesthesia for breast surgeries. A precise impact of these new methods of analgesia on the surgical stress response remains to be discovered. The goal of the research: to investigate surgical stress-response of the breast cancer surgical patient after Pectoral nerve block, Paravertebral block, or general anesthesia. Materials and methods. This is single center, prospective study. Ninety-one women after an elective mastectomy or quadrantectomy with axillary nodes dissection were included. Depending on the method of anesthesia, patients were randomly divided into three groups. The General Anesthesia group (GA) — only general anesthesia, PB group — general anesthesia plus pectoral nerve block type II with ropivacaine 0.375% 30 ml and PVB group — general anesthesia plus thoracic paravertebral block with ropivacaine 0.5% 20 ml. All blocks were performed under ultrasound control. The plasma levels of CRP, IL-6 were measured before and 24 hours after surgery. The plasma level of Cortisol was measured before surgery, 0 and 24 hours after. Postoperative pain was evaluated using the Numerical rating scale (NRS) at 0, 1, 2, 6, 12, 18 and 24 hours after surgery. Results. The initial (preoperative) levels of biomarkers were equal in three investigation groups. Immediate after surgery Cortisol level decreased in PB and PVB groups to 267 (182- 416) nmol/l and 311 (196-378) nmol/l respectively and increased in GA group to 355 (246-483) nmol/l, but without statistically significance (р=0.132). The day after surgery Cortisol’s level was: 340 (253-381) nmol/l; 314 (231-416) nmol/l and 339 (228-398) nmol/l respectively (р=0.678). The day after surgery C-reactive protein was statistically significant lower in blocks groups. It was achieved in GA group 83.0 (51.3-94.0) mg/l, PB group – 51.9 (36.1-79.5) mg/l, PVB group – 61.7 (25.6-73.9) mg/l (р=0.062). In a day after surgery the highest level of IL-6 was observed in the GA group, then in the PB and PVB groups: 29.5 (16.9-33.1) pg/ml, 22.2 (11.5-31.6) pg/ml and 16.8 (14.0-19.5) pg/ml respectively (р=0.002). Statistically significantly lower NRS pain scores were observed in the PB and PVB groups compared with the GA group in 1, 2, 6 and 24 hours after surgery. Conclusion. Analgesia with both pectoral nerve block or thoracic paravertebral block compared to general anesthesia alone for breast cancer surgery is associated with lower postoperative levels of CRP and IL-6, which suggest about decreasing stress-response to the surgery.

scholarly journals Clinical analgesic efficacy of pectoral nerve block in patients undergoing breast cancer surgery

Medicine ◽  
2020 ◽  
Vol 99 (14) ◽  
pp. e19614
Author(s):  
Qianchuang Sun ◽  
Shuyan Liu ◽  
Huiying Wu ◽  
Wenyue Kang ◽  
Shanshan Dong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Nerve Block ◽  
Analgesic Efficacy ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Pectoral Nerve
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