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Breast surgery and peripheral blocks. Is it worth it?

Ulrich Schwemmer¹

¹Department of Anesthesiology and Intensive Care Medicine, Kliniken des Landkreises Neumarkt i.d. Opf, Neumarkt, Germany.

Current Opinion in Anaesthesiology

|April 24, 2020

Summary

Peripheral nerve blocks, like the Pecs II block, effectively manage breast surgery pain. Ultrasound-guided Pecs II is the best option to reduce or avoid intraoperative and postoperative opioid use.

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A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery

A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery

Published on: January 18, 2018

Area of Science:

Anesthesiology
Pain Management
Surgical Innovation

Background:

Peripheral nerve blocks have emerged as a significant advancement in perioperative pain management.
Breast surgery presents unique challenges for pain control, often requiring multimodal approaches.

Purpose of the Study:

To evaluate the potential of recently developed peripheral nerve blocks for perioperative pain management in breast surgery.
To assess the clinical efficacy and necessity of these novel nerve blocks.

Main Methods:

Review of existing literature, including case reports, cadaver studies, randomized controlled trials (RCTs), and meta-analyses.
Focus on the Pectoral nerve block (Pecs) block and its variations, as well as the Erector Spinae plane (ESP) block.

Main Results:

The modified Pecs block (Pecs II) has demonstrated a reduction in postoperative opioid consumption.
The Erector Spinae plane block shows superiority to control groups in reducing postoperative morphine requirements.
Studies indicate low intraoperative opioid doses and manageable postoperative pain scores with these techniques.

Conclusions:

The Pecs II block is identified as the optimal choice for perioperative pain relief in breast surgery, aiming to reduce or eliminate opioid requirements.
The decision to implement additional nerve blocks must balance pain reduction benefits against potential risks and resource utilization.