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Pain

Breast Diseases

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Central Nervous System Depressants

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Analgesics

Anesthetics

Bupivacaine

Intraoperative modified PEC block with 0.5% bupivacaine 20 ml plus adrenaline 100 ug by surgeon

Preoperative thoracic paravertebral nerve block with 0.5% bupivacaine 20 ml plus adrenaline 100 ug and intraoperative modified PEC block with 0.5% bupivacaine 20 ml plus adrenaline 100 ug by surgeon

Ultrasound-guided thoracic paravertebral blocks in T2, T4 level

Thoracic paravertebral block under ultrasound guidance

Pectoral nerve block by surgeon under direct vision after total mastectomy

Intraoperative modified PEC block

General anesthesia with endotracheal intubation

GA with ETT

Suwimon Tangwiwat, MD

Suwimon Tangwiwat, M.D

To compare efficacy and safety of adding thoracic paravertebral nerve blocks to modified PEC block versus modified PEC block only in breast cancer surgery. This study evaluate systemic opioid requirement in 48 hours in primary outcome and the analgesic profile ( pain score at rest and on shoulder movement), opioid-related side effects and nerve blocks complications.

Regional anesthesia has been used and studied extensively in breast surgery as an opioid-sparing strategy, with block of the intercostal supply by thoracic paravertebral block (TPVB) becoming a popular technique.

This prospective randomized controlled trial is aimed to study the proper regional nerve block technique to reach the postoperative opioid-free requirement modality for breast cancer surgery.

group A Intraoperative modified PEC block only group B Preoperative thoracic paravertebral block plus intraoperative modified PEC block

Randomized group of patient is identified and sealed in envelope. There is not written group in anesthetic record. Postoperative outcomes are assessed by Acute Pain Service nurse or a resident (co-investigator who blinds to the technique).

Analgesic Effect of Adding Thoracic Paravertebral Nerve Blocks to Modified PEC Block in Breast Cancer Surgery

Analgesic Effect of Adding Thoracic Paravertebral Nerve Blocks to Modified PEC Block in Breast Cancer Surgery, Prospective Randomized Controlled Study

Cumulative fentanyl consumption within postoperative 24 hours

Cumulative fentanyl consumption within postoperative 24-48 hours

Dosage of intraoperative fentanyl usage in micrograms

Numeric rating score 0-10 (0= no pain, 10= worst pain imaginable)

Numeric rating score ((0= no pain, 10= worst pain imaginable)

time to require fentanyl patient-controlled intravenous analgesia

adverse effects include postoperative nausea, vomiting, dizziness, pruritus

nerve block complications include pneumothorax, hypotension, local anesthetic systemic toxicity, Horner syndrome

Satisfaction scale score 0-10 (0= highly unsatisfied, 10= highly satisfied)

Cost of adding nerve block and postoperative pain score

Spots Global Cancer Trial Database for modified pec block