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. 2019 Jul;63(7):530-536.
doi: 10.4103/ija.IJA_222_19.

Is COMBIPECS the answer to perioperative analgesia for breast surgery? A double blinded randomized controlled trial

Rakhi Khemka  1 , Arunangshu Chakrborty  1 , Sanjit Agrawal  2 , Rosina Ahmed  2
Affiliations

Is COMBIPECS the answer to perioperative analgesia for breast surgery? A double blinded randomized controlled trial

Rakhi Khemka et al. Indian J Anaesth. 2019 Jul.

Abstract

Background and aims: Pecs block and its variations provides perioperative analgesia, reduce PONV and other opioid related side effects. We hypothesized that COMIBPES block in addition to general anaesthesia will provide better postoperative analgesia when compared to general anaesthesia alone in breast cancer surgery patients.

Methods: After obtaining permission from the institutional review board and registering the trial with Clinical Trials Registry of India (CTRI), we conducted a double blinded randomized controlled trial of 100 patients posted for elective breast surgery with axillary dissection. Patients were divided into two groups, P (Pecs block) and C (control). Intraoperative analgesia, postoperative analgesia, postoperative nausea vomiting (PONV) and shoulder mobility on first postoperative day (POD1) were noted. Primary outcomes were the pain scores measured by visual analog scale (VAS) and cumulative intravenous morphine consumption from patient controlled analgesia (PCA) pump at measurement intervals of 0, 1, 4, 8, 12 and 24 hours postoperatively.

Results: Intraoperatively, Group P patients did not require any additional analgesia, whereas all the patients in Group C required additional intraoperative morphine (mean, SD: 5.12, 2.63 mg, compared to nil in group P, P< 0.01). COMBIPECS block group had lower pain scores and PCA morphine requirements, less PONV and better shoulder mobility on POD1.

Conclusion: COMBIPECS block is a valuable addition to general anaesthesia for breast cancer surgery as it reduces pain and PONV while allowing better postoperative shoulder mobility.

Keywords: Breast surgery; chest wall; regional anesthesia; ultrasound.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Ultrasound images of COMBIPECS block showing (a) Initial ultrasonogram, (b) Needle entry and rib strike, (c) LA injected at the intended planes while withdrawing
Figure 2
Figure 2
CONSORT diagram
Figure 3
Figure 3
(a) Mean pain scores at studied intervals. X axis: time, Y axis: mean VAS score. (b) PCA morphine cumulative readings at measuring intervals. X axis: time, Y axis: cumulative morphine consumption (mg)
See this image and copyright information in PMC

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