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Bilateral PECS II Block is Associated with Decreased Opioid Consumption and Reduced Pain Scores for up to 24 hours
Gokhan Sertcakacilar1, Selcuk Kose2
1Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Anesthesiology and Reanimation, University of Health Science, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, TURKEY.
Objective(S):
Compared to the open surgical technique, the minimally invasive repair of pectus excavatum (MIRPE; Nuss procedure) is a thoracoscopic technique designed to minimize intraoperative tissue damage. It still causes severe postoperative pain due to the insertion and pressure of the retrosternal bar used to raise the sternum and stabilize the chest. This study aimed to identify associations between ultrasound-guided PECS-II block and postoperative analgesia after the Nuss procedure.
Design:
A retrospective cohort study SETTING: Single-center, training and research hospital affiliated with a university PARTICIPANTS: From Jan 1, 2018 to Nov 15, 2021, 171 consecutive patients were identified who underwent MIRPE surgery under general anesthesia. All patients received intravenous (I) patient-controlled analgesia (PCA) with or without PECS-II blocks for postoperative analgesia. One hundred twenty-five patients who met the inclusion criteria were evaluated.
Interventions:
Demand-only morphine intravenous PCA was used for postoperative pain management in the PECS and control groups. Bilateral PECS-II block with 0.25% bupivacaine was performed in to the PECS group.
Measurements And Main Results:
The primary outcome was postoperative opioid consumption, calculated as mg/kg of IV morphine. Secondary outcomes included Numeric Rating Scale (NRS) pain scores at rest (static) and with movement (dynamic) recorded 1, 4, 8, 12, 24 h after surgery. Postoperative morphine consumption was significantly lower in the PECS group than in the control group over the first 24 hours postoperatively: 0.325 mg/kg vs. 0.425 mg/kg (p<0.001). Static and dynamic NRS values were significantly lower in the PECS group for the first 12 postoperative hours (p <0.05).
Conclusions:
Bilateral PECS-II block is associated with decreased pain scores for up to 12 hours, and with decreased opioid consumption for up to 24 hours, following minimally invasive repair of pectus excavatum (Nuss procedure) in adolescents. PECS-II block in this context has not been previously described.
Insights
Ultrasound-guided PECS-II blocks significantly reduced pain and opioid consumption in adolescents undergoing minimally invasive repair of pectus excavatum (Nuss procedure). This technique offers improved postoperative analgesia for this specific surgical repair.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Pain Management
Background:
- Minimally invasive repair of pectus excavatum (MIRPE), or the Nuss procedure, effectively corrects chest wall deformities but causes significant postoperative pain.
- Current pain management relies on patient-controlled analgesia (PCA), which may not fully alleviate discomfort associated with the retrosternal bar.
- The Pectoral nerve block type II (PECS-II) block is an ultrasound-guided regional anesthesia technique with potential for thoracic surgery analgesia.
Purpose of the Study:
- To evaluate the effectiveness of ultrasound-guided PECS-II block in managing postoperative pain after the Nuss procedure.
- To compare opioid consumption and pain scores between patients receiving PCA with or without PECS-II block.
Main Methods:
- A retrospective cohort study was conducted on 125 adolescent patients who underwent MIRPE.
- Patients received either intravenous morphine PCA alone (control group) or PCA combined with bilateral PECS-II blocks (PECS group).
- Postoperative morphine consumption and Numeric Rating Scale (NRS) pain scores (static and dynamic) were analyzed.
Main Results:
- The PECS group demonstrated significantly lower postoperative morphine consumption (0.325 mg/kg vs. 0.425 mg/kg, p<0.001) over 24 hours compared to the control group.
- Static and dynamic NRS pain scores were significantly lower in the PECS group within the first 12 postoperative hours (p <0.05).
Conclusions:
- Bilateral PECS-II block provides effective postoperative analgesia following the Nuss procedure in adolescents.
- This regional anesthesia technique is associated with reduced pain and opioid requirements for up to 12-24 hours post-surgery.
- The use of PECS-II block for analgesia after MIRPE has not been previously described in the literature.
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