To Evaluate Analgesic Effect of Ultrasound Guided Pectoral Nerves I and II Blocks in Multimodal Analgesia for Breast Cancer Surgery
Author(s): Aidal, Nyla Farooq, Hina Bashir, Abrak Asma*
Background: Postoperative pain management is a matter of concern for every anaesthesiologist. Postoperative pain control may result in improved cost effectiveness, more appropriate and efficient use of resources, and ultimately improved patient satisfaction. Aim: To evaluate analgesic effect of ultrasound guided pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery. Methods: This prospective observational study “Ultrasound guided pectoral nerves block as intraoperative and postoperative analgesia for breast cancer surgery” was conducted in postgraduate department of Anaesthesiology, critical care, and pain medicine at SMHS hospital and super speciality hospital, the associated hospitals of Government Medical College, Srinagar from 2018 to 2020 over a period of 18 months. We observed 68 patients over a period of eighteen months who had undergone breast cancer surgery. All patients received total 30 ml of 0.2% ropivacaine and 3ml 2% lignocaine which was a routine protocol in our institute. Sensory block assessment was done at 5 minutes intervals after completion of procedure up to 30 minute. A total sample size of 68 patients was calculated using PASSE (power and sample estimation) for study design and analysis. To obtain a 68 study sample size and design, a total of 88 patients were included in which 20 patients were excluded on the basis of study design and exclusion criteria. Statistical analysis was performed using Microsoft (MS) Office Excel Software (Microsoft Excel, Redmond, Washington: Microsoft 2003, Computer software). Results were expressed as mean ± standard deviation, number, and percentage (%). Data were analysed using post hoc analysis method. Normally distributed data were assessed using unpaired Student’s t?test. Results: Mean postoperative visual analogue scale score of study patients at 2, 6, 12, 24 hours. Mean VAS scores at 2-hour, 6-hour, 12-hour, 24 hours were 1.10 ± 0.18, 3.1.70 ± 1.10, 1.80 ± 1.50, 1.98 ± 1.43. Overall mean VAS score in the postoperative period is 2.20 ± 1.70 with minimum score of 1 and maximum score of 4. Time to request for first analgesia in study patients. Out of 68 patients 83.35% of patients requested for analgesia in first 24 hours. Mean time to request for first analgesia was 12.4 ± 7.80 hours with minimum requirement at 6 hour and maximum requirement at 24 hours. Conclusion: The pectoral nerves I and II blocks produce excellent analgesia when combined with general anaesthesia for breast cancer surgery. They are simple, easy-to-learn techniques, having easily identifiable landmarks based on good anatomical and ultrasound knowledge, making them an excellent alternative to the conventional thoracic paravertebral and neuraxial blocks for modified radical mastectomy, with or without axillary lymph node dissection.