Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Oct;30(10):6010-6021.
doi: 10.1245/s10434-023-13890-w. Epub 2023 Aug 1.

A Randomized Single-Blinded Study Comparing Preoperative with Post-Mastectomy PECS Block for Post-operative Pain Management in Bilateral Mastectomy with Immediate Reconstruction

Ingrid M Lizarraga  1   2 , K Huang  3   4 , B Yalamuru  5 , S L Mott  4 , Z A Sibenaller  4 , J N Keith  4   6 , S L Sugg  3   4 , L M Erdahl  3   4 , M Seering  7
Affiliations
Randomized Controlled Trial

A Randomized Single-Blinded Study Comparing Preoperative with Post-Mastectomy PECS Block for Post-operative Pain Management in Bilateral Mastectomy with Immediate Reconstruction

Ingrid M Lizarraga et al. Ann Surg Oncol. 2023 Oct.

Abstract

Background: Ultrasound-guided pectoralis muscle blocks (PECS I/II) are well established for postoperative pain control after mastectomy with reconstruction. However, optimal timing is unclear. We conducted a randomized controlled single-blinded single-institution trial comparing outcomes of block performed pre-incision versus post-mastectomy.

Method: Patients with breast cancer undergoing bilateral mastectomy with immediate expander/implant reconstruction were randomized to receive ultrasound-guided PECS I/II either pre-incision (PreM, n = 17) or post-mastectomy and before reconstruction (PostM, n = 17). The primary outcome was the average pain score using the Numerical Rating Score during post-anesthesia care unit (PACU) and inpatient stay, with the study powered to detect a difference in mean pain score of 2. Secondary outcomes included mean pain scores on postoperative day (POD) 2, 3, 7, 14, 90, and 180; pain catastrophizing scores; narcotic requirements; PACU/inpatient length of stay; block procedure time; and complications.

Result: No significant differences between the two groups were noted in average pain score during PACU (p = 0.57) and 24-h inpatient stay (p = 0.33), in the 2 weeks after surgery at rest (p = 0.90) or during movement (p = 0.30), or at POD 90 and 180 at rest (p = 0.42) or during movement (p = 0.31). Median duration of block procedure (PreM 7 min versus PostM 6 min, p = 0.21) did not differ. Median PACU and inpatient length of stay were the same in each group. Inpatient narcotic requirements were similar, as were length of stay and post-surgical complication rates.

Conclusion: Intraoperative ultrasound-guided PECS I/II block administered by surgeons following mastectomy had similar outcomes to preoperative blocks.

Trial registration: This trial is registered with Clinical Research Information Service (NCT03653988).

PubMed Disclaimer

Comment in

References

    1. Cemal Y, Albornoz CR, Disa JJ, et al. A paradigm shift in U.S. breast reconstruction: Part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg. 2013;131(3):320e–6e. https://doi.org/10.1097/PRS.0b013e31827cf576 . - DOI
    1. Amaya F, Hosokawa T, Okamoto A, et al. Can acute pain treatment reduce postsurgical comorbidity after breast cancer surgery? A literature review. Biomed Res Int. 2015;2015:641508. https://doi.org/10.1155/2015/641508 . - DOI - PubMed - PMC
    1. Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain. 2011;12(7):725–46. https://doi.org/10.1016/j.jpain.2010.12.005 . - DOI - PubMed
    1. Johnson AC, Colakoglu S, Reddy A, et al. Perioperative blocks for decreasing postoperative narcotics in breast reconstruction. Anesth Pain Med. 2020;10(5):e105686. https://doi.org/10.5812/aapm.105686 . - DOI - PubMed - PMC
    1. Schnabel A, Reichl SU, Kranke P, et al. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2010;105:842–52. https://doi.org/10.1093/bja/aeq265 . - DOI - PubMed

Publication types

Substances

Associated data

LinkOut - more resources