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Zafar S, Khan R, Akbar MA, Zameer R, Malik J, Akhtar W, Mehmoodi A, Awais M. Pectoral Nerve Block II for Cardiac Implantable Electronic Devices. Ann Noninvasive Electrocardiol 2024; 29:e70005. [PMID: 39148302 PMCID: PMC11327295 DOI: 10.1111/anec.70005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/24/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
AIM This study aimed to assess the feasibility and effectiveness of the pectoral nerves (PECS) II block in facilitating cardiac implantable electronic device (CIED) insertion in a sample of 120 patients, with a focus on the percentage of cases completed without additional intraoperative local anesthesia. METHODS PECS II blocks were performed on the left side using ultrasound guidance in all 120 patients. Feasibility was assessed by the proportion of cases completed without the need for extra intraoperative local anesthetic. Secondary outcomes included the amount of additional local anesthetic used, intraoperative opioid requirements, postoperative pain scores, time to first postoperative analgesia, analgesic consumption, patient satisfaction, and block-related complications. RESULTS Of the 120 patients, 78 (65%) required additional intraoperative local anesthetic, with a median volume of 8.2 mL (range 3-13 mL). Fifteen patients (12.5%) needed intraoperative opioid supplementation. Nine patients (7.5%) required postoperative tramadol for pain relief. In total, 98 patients (81.7%) reported high satisfaction levels with the procedure. CONCLUSIONS The PECS II block, when combined with supplementary local anesthetic, provided effective postoperative analgesia for at least 24 h in 120 patients undergoing CIED insertion. While it did not completely replace surgical anesthesia in most cases, the PECS II block significantly contributed to a smoother intraoperative experience for patients.
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Ichinose J, Kobayashi N, Fukata K, Kanno K, Suzuki A, Matsuura Y, Nakao M, Okumura S, Mun M. Accuracy of thoracic nerves recognition for surgical support system using artificial intelligence. Sci Rep 2024; 14:18329. [PMID: 39112794 PMCID: PMC11306550 DOI: 10.1038/s41598-024-69405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
We developed a surgical support system that visualises important microanatomies using artificial intelligence (AI). This study evaluated its accuracy in recognising the thoracic nerves during lung cancer surgery. Recognition models were created with deep learning using images precisely annotated for nerves. Computational evaluation was performed using the Dice index and the Jaccard index. Four general thoracic surgeons evaluated the accuracy of nerve recognition. Further, the differences in time lag, image quality and smoothness of movement between the AI system and surgical monitor were assessed. Ratings were made using a five-point scale. The computational evaluation was relatively favourable, with a Dice index of 0.56 and a Jaccard index of 0.39. The AI system was used for 10 thoracoscopic surgeries for lung cancer. The accuracy of thoracic nerve recognition was satisfactory, with a recall score of 4.5 ± 0.4 and a precision score of 4.0 ± 0.9. Though smoothness of motion (3.2 ± 0.4) differed slightly, nearly no difference in time lag (4.9 ± 0.3) and image quality (4.6 ± 0.5) between the AI system and the surgical monitor were observed. In conclusion, the AI surgical support system has a satisfactory accuracy in recognising the thoracic nerves.
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M Sethuraman R. Feasibility of Selective Dorsal Scapular Nerve and Long Thoracic Nerve Blocks in Scapulothoracic Arthrodesis Surgery. A A Pract 2024; 18:e01835. [PMID: 39145588 DOI: 10.1213/xaa.0000000000001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
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Xue B, Tian T, Xue FS. Letter to the Editor: Comment on McLaughlin et al. Comparison of Tumescent Anesthesia Versus Pectoral Nerve Block in Bilateral Reduction Mammaplasty ( Ann Plast Surg 2023; 90(6S Suppl 5):S533-S537). Ann Plast Surg 2024; 92:484. [PMID: 38320003 DOI: 10.1097/sap.0000000000003789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Ferreira-Silva N, Hurdle MFB, Clendenen SR, Gulati A, McLaughlin SA, Troyer W, Rosario-Concepción RA. Ultrasound-guided fascial plane blocks for post-breast surgery pain syndrome. Pain Pract 2024; 24:677-685. [PMID: 38170566 DOI: 10.1111/papr.13341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Persistent pain following breast surgery is common and may be challenging to treat. In patients refractory to conservative treatments, ultrasound-guided fascial plane blocks of thoracic nerves can be a useful option. RESULTS This type of neuro blockade technique provides advantages in terms of safety and efficacy that are convenient for physicians managing refractory and complex cases of post-breast surgery syndrome. CONCLUSION This technical review aims to present an up-to-date summary of the most common ultrasound-guided fascial plane blocks for chronic pain in post-breast surgery patients, provide a detailed technical description of each intervention, and propose preferred injections based on the anatomical location of the pain.
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Wallace AB, Song S, Yeh P, Kim EA. The Effect of Pectoral Nerve Blocks on Opioid Use and Postoperative Pain in Masculinizing Mastectomy: A Randomized Controlled Trial. Plast Reconstr Surg 2024; 153:570-577. [PMID: 37220393 DOI: 10.1097/prs.0000000000010707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Bilateral masculinizing mastectomy is the most common gender-affirmation operation performed. Currently, there is lack of data regarding intraoperative and postoperative pain control for this population. It is the authors' aim to study the effects of the pectoral nerve (Pecs) I and II regional nerve blocks in patients undergoing masculinizing mastectomy. METHODS A randomized, double-blind, placebo-controlled trial was performed. Patients undergoing bilateral gender-affirmation mastectomy were randomized to receive either a Pecs block with ropivacaine or placebo injection. The patient, surgeon, and anesthesia team were blinded to the allocation. Intraoperative and postoperative opioid requirements were collected and recorded as morphine milligram equivalents (MME). Participants recorded postoperative pain scores at specific time points on the day of surgery through postoperative day 7. RESULTS Fifty patients were enrolled between July of 2020 and February of 2022. Twenty-seven were randomized to the intervention group and 23 to the control group, with 43 patients undergoing analysis. There was no significant difference in intraoperative MME between the Pecs block group and the control group (9.8 versus 11.1; P = 0.29). In addition, there was no difference in postoperative MME between the groups (37.5 versus 40.0; P = 0.72). Postoperative pain scores were also similar between the groups at each specified time point. CONCLUSIONS There was no significant reduction in opioid consumption or postoperative pain scores in patients undergoing bilateral gender-affirmation mastectomy who received a regional anesthetic when compared with placebo. In addition, a postoperative opioid-sparing approach may be appropriate for patients undergoing bilateral masculinizing mastectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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Gürkan Y, Şimşek D, Güllü B, Manici M, Darçin K, Yürük B, Demirhan M, Eren İ. Selective Dorsal Scapular Nerve and Long Thoracic Nerve Blocks for Rescue Analgesia in Scapulothoracic Arthrodesis Surgery: A Case Report. A A Pract 2024; 18:e01765. [PMID: 38498675 DOI: 10.1213/xaa.0000000000001765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Scapulothoracic arthrodesis (STA) surgery is performed to stabilize the scapula in patients with facioscapulohumeral dystrophy (FSHD). Postoperative pain could be a major problem even while using erector spinae plane block (ESPB). We performed a preoperative ESPB with an intraoperative ESPB catheter, but rescue analgesia was needed for pain in the periscapular area in the postoperative period. The patient's pain score was reduced by applying an ultrasound-guided dorsal scapular nerve (DSN) and long thoracic nerve (LTN) block. Selective DSN and LTN blocks can be effective in enhancing postoperative analgesia in STA surgery.
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Berli JU, Togioka BM. Discussion: The Effect of Pectoral Nerve Blocks on Opioid Use and Postoperative Pain in Masculinizing Mastectomy: A Randomized Controlled Trial. Plast Reconstr Surg 2024; 153:578-579. [PMID: 38385721 DOI: 10.1097/prs.0000000000011119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
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Sforza M, Saghir R, Saghir N, Husein R, Okhiria R, Okhiria T, Sidhu M, Poojary M. Assessing the Efficacy of the S-PECS Block in Breast Augmentation Surgery: A Randomized, Double-Blind, Controlled Trial. Plast Reconstr Surg 2024; 153:1e-9e. [PMID: 37010475 DOI: 10.1097/prs.0000000000010492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Postoperative acute and chronic pain following breast surgery is a common complication that needs resolving to allow for improved patient outcomes. Previously, thoracic epidurals and paravertebral blocks have been the accepted standard administered intraoperatively. However, more recently the introduction of the pectoral nerve block (PECS and PECS-2 blocks) has appeared promising to control the pain more effectively, but further robust analysis is required to prove its efficacy. The authors aim to study the efficacy of a new block, S-PECS, that combines a serratus anterior and a PECS-2 block. METHODS In this study, the authors performed a single-center, randomized, controlled, double-blind group trial in 30 female patients undergoing breast augmentation surgery with silicone breast implants and the S-PECS block. Divided into two groups of 15, the PECS group received local anesthetics and the no-PECS control group received a saline injection. All participants were followed up at recovery and at 4, 6, and 12 hours postoperatively. RESULTS The authors' results showed that the pain score in the PECS group was significantly less than in the no-PECS group across all time points: recovery, and at 4, 6, and 12 hours. Furthermore, the patients who received the S-PEC block were 74% less likely to request pain medications compared with the no-PECS group ( P < 0.05). CONCLUSION Overall, the modified S-PECS block is an effective, efficient, and safe method of controlling pain in patients undergoing breast augmentation surgery, with additional applications yet to be explored.
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Yang H, Wang H, Wang Q. The analgesic efficacy of pectoral nerve block for breast augmentation: a meta-analysis of randomized controlled studies. J Plast Surg Hand Surg 2023; 58:142-148. [PMID: 38095482 DOI: 10.2340/jphs.v58.9395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/18/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Many patients suffered from serious pain after breast augmentation, but the analgesic efficacy of pectoral nerve block for these patients was not well established. Thus, this meta-analysis was intended to study the analgesic efficacy of pectoral nerve block for breast augmentation. METHODS Several databases including PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases were searched, and we included randomized controlled trials (RCTs) regarding the analgesic efficacy of pectoral nerve block for breast augmentation. RESULTS Six RCTs were ultimately included in this meta-analysis. Compared with control intervention for breast augmentation, pectoral nerve block could significantly reduce pain scores at 1 h (mean difference [MD] = -2.28; 95% confidence interval [CI] = -3.71 to -0.85; P = 0.002), 2 h (MD = -3.08; 95% CI = -3.95 to -2.20; P < 0.00001), 4 h (MD = -2.95; 95% CI = -3.32 to -2.58; P < 0.00001), 6-8 h (MD = -2.68; 95% CI = -3.24 to -2.11; P < 0.00001), 24 h (MD = -2.04; 95% CI = -2.41 to -1.67; P < 0.00001), the number of analgesic requirement (odd ratio [OR] = 0.20; 95% CI = 0.09 to 0.45; P = 0.0001), and the incidence of nausea (OR = 0.21; 95% CI = 0.08 to 0.54; P = 0.001) and vomiting (OR = 0.15; 95% CI = 0.05 to 0.39; P = 0.0001). Conclusions: Pectoral nerve block may be effective for pain relief after breast augmentation.
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Conti D, Valoriani J, Ballo P, Pazzi M, Gianesello L, Mengoni V, Criscenti V, Gemmi E, Stera C, Zoppi F, Galli L, Pavoni V. The clinical impact of pectoral nerve block in an 'enhanced recovery after surgery' program in breast surgery. Pain Manag 2023; 13:585-592. [PMID: 37937422 DOI: 10.2217/pmt-2023-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background: Pectoral nerve block (PECS) is increasingly performed in breast surgery. Aim: The study evaluated the clinical impact of these blocks in the postoperative course. Patients & methods: In this case-control study, patients undergoing breast surgery with 'enhanced recovery after surgery' pathways were divided into group 1 (57 patients) in whom PECS was performed before general anesthesia, and group 2 (57 patients) in whom only general anesthesia was effected. Results: Postoperative opioid consumption (p < 0.002), pain at 32 h after surgery (p < 0.005) and the length of stay (p < 0.003) were significantly lower in group 1. Conclusion: Reducing opioid consumption and pain after surgery, PECS could favor a faster recovery with a reduction in length of stay, ensuring a higher turnover of patients undergoing breast surgery.
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Elhaddad AM, Hefnawy SM, El-Aziz MA, Ebraheem MM, Mohamed AK. Pectoral nerve blocks for transvenous subpectoral pacemaker insertion in children: a randomized controlled study. Korean J Anesthesiol 2023; 76:424-432. [PMID: 36632640 PMCID: PMC10562074 DOI: 10.4097/kja.22681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Postoperative pain management after pacemaker insertion routinely requires opioid agents, nonsteroidal anti-inflammatory drugs, or paracetamol. However, interest in opioid-sparing multimodal pain management to minimize postoperative narcotic use has increased recently. This study aimed to assess the pectoral nerve (PECS) block versus standard treatment on postoperative pain control and opioid consumption in pediatric patients after transvenous subpectoral pacemaker insertion. METHODS In this randomized controlled study, 40 pediatric patients underwent transvenous subpectoral pacemaker insertion with either congenital or postoperative complete heart block. Patients were randomly assigned to two groups: Group C (control) received conventional analgesic care without any block and Group P (pectoral) received a PECS block. Demographics, procedural variables, postoperative pain, and postoperative opioid consumption were compared between the two groups. RESULTS In children undergoing transvenous subpectoral pacemaker insertion, the PECS block was associated with a longer procedure time; however, the cumulative dose of fentanyl and atracurium was reduced and the hemodynamic profile was superior in Group P compared with Group C intraoperatively. Postoperatively, the PECS block was associated with lower postprocedural pain scores, which was reflected by the longer interval before the first call for rescue analgesia and lower postoperative morphine consumption, without an increase in the rate of complications. CONCLUSION Ultrasound-guided PECS blocks are associated with a good intraoperative hemodynamic profile, reduced postoperative pain scores, and lower total opioid consumption in children undergoing transvenous subpectoral pacemaker placement.
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Liang Z, Xu Y. The efficacy of pectoral nerve block for pain control after breast augmentation: A meta-analysis of randomized controlled studies. Medicine (Baltimore) 2023; 102:e32863. [PMID: 36827054 PMCID: PMC11309730 DOI: 10.1097/md.0000000000032863] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The efficacy of pectoral nerve block for pain control remains unknown in patients undergoing breast augmentation. This meta-analysis aims to explore the analgesic efficacy of pectoral nerve block for breast augmentation. METHODS We systematically searched PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases, and included randomized controlled trials reporting pectoral nerve block versus no block for breast augmentation. RESULTS Five randomized controlled trials were included in this meta-analysis. Compared with control group after breast augmentation, pectoral nerve block was associated with substantially reduced pain scores at 1 hour (standard mean difference [SMD] = -1.63; 95% confidence interval [CI] = -2.81 to -0.44; P = .007), maximal pain scores at 1 to 6 hours (SMD = -1.72; 95% CI = -2.75 to -0.69; P = .001) and 6 to 24 hours (SMD = -2.06; 95% CI = -3.40 to -0.72; P = .003), rescue analgesic (odd ratio = 0.17; 95% CI = 0.05-0.57; P = .004), nausea (SMD = 0.21; 95% CI = 0.08-0.54; P = .001), and vomiting (odd ratio = 0.15; 95% CI = 0.05-0.39; P = .0001). CONCLUSIONS Pectoral nerve block benefits to alleviate pain intensity after breast augmentation.
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Leite ALDS, Rocha FTR, Oliveira MJC, Barros AV, Santos SMLD, Silva AMRDA, Silvestre DWDEA, Folha Filho EAC, Ferro CC, Bezerra TS, Fachin LP, Santos DC, Fraga CADEC, Sales-Marques C. Impact of Pectoralis Nerve Block (PECS) on postoperative pain in patients submitted to mastectomy with lymphadenectomy. Rev Col Bras Cir 2022; 49:e20223366. [PMID: 36515333 PMCID: PMC10578795 DOI: 10.1590/0100-6991e-20223366-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Breast cancer is the most common malignant neoplasm in women worldwide. Surgery has been traditional treatment and, generally, it´s mastectomy with lymphadenectomy, that can causes postoperative pain. Therefore, we seek to study regional anesthesic techniques that can minimize this effect, such as the interpectoral block (PECS). METHODS randomized controlled study with 82 patients with breast cancer who underwent mastectomy with lymphadenectomy from January 2020 to October 2021 in oncology hospital. INTERVENTIONS two randomized groups (control - exclusive general anesthesia and PECS group - received PECS block with levobupivacaine/ropivacaine and general anesthesia). We applied a questionnaire with Numeric Rating Scale for pain 24h after surgery. We used Shapiro-Wilk, Mann-Whitney and Chi-square tests, and analyzed the data in R version 4.0.0 (ReBEC). RESULTS in the PECS group, 50% were pain-free 24h after surgery and in the control group it was 42.86%. The majority who presented pain classified it as mild pain (VAS from 1 to 3) - (42.50%) PECS group and (40.48%) control group (p=0.28). Only 17.50% consumed opioids in the PECS group, similar to the control group with 21.43%. (p=0.65). There was a low rate of complications such as PONV in both groups. In the subgroup analysis, there was no statistical difference between the groups that used levobupivacaine or ropivacaine regarding postoperative pain and opioid consumption. DISCUSSION the studied group had a low rate of pain in the postoperative period and it influenced the statistical analysis. There wasn´t difference in postoperative pain in groups. CONCLUSION was not possible to demonstrate better results with the association of the PECS block with total intravenous analgesia. Need further studies to assess the efficacy of the nerve block.
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Bagaphou TC, Santonastaso DP, Cerotto V, Carli L, Cordellini M, Chiotti V, Martinelli S, Fusco P, Gori F. Combined PECs II block with parasternal block for awake radical mastectomy. Minerva Anestesiol 2022; 88:1078-1079. [PMID: 36282229 DOI: 10.23736/s0375-9393.22.16785-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
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Wei Z, Lei GY, Wu LL, Xi CH, Yin Y, Wang GY. [Effect of ultrasound-guided serratus plane block combined with pectoral nerve block I on postoperative analgesia after radical mastectomy]. ZHONGHUA YI XUE ZA ZHI 2022; 102:2278-2282. [PMID: 35927059 DOI: 10.3760/cma.j.cn112137-20220513-01048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To study the effect of ultrasonic-guided serratus plane block combined with pectoral nerve block Ⅰ on postoperative analgesia after radical mastectomy. Methods: A total of 30 patients, all female, aged [M (Q1, Q3)] 53 (43, 62) years old, who underwent radical mastectomy in Beijing Tongren Hospital from May to August 2021 were selected. The patients were divided into two groups (n=15 in each group) using a random number table: general anesthesia alone+patient controlled intravenous analgesia (PCIA) group (control group) and serratus plane block combined with pectoral nerve block Ⅰ before general anesthesia+PCIA group (combined group). Numerical rating scale (NRS) at rest in both groups were detected in the post anesthesia care unit (PACU) and 4, 8, 12, 24, 36 and 48 h after operation. The time of first pain, the time of first pressing of the automatic analgesic device after the operation, the dosage of remifentanil during operation, cumulative dosages of sufentanil at 24 h and 48 h postoperatively, and the incidence of adverse effects were all recorded. Results: The NRS scores in combined group in the PACU and 4, 8, 12 and 24 h after surgery were (2.1±1.7), (1.7±1.5), (1.5±1.4), (1.5±1.3) and (1.7±1.3), respectively, while the NRS scores in control group at each time points were (4.5±2.0), (3.2±1.4), (2.7±0.9), (2.8±0.9) and (2.4±0.8), respectively, and the NRS scores in combined group were significantly lower than those in control group (all P<0.05). The NRS scores in combined group at 36 and 48 h after surgery were (1.8±1.6) and (1.6±1.2), while the NRS scores in control group were (2.2±0.9) and (2.1±0.8), and the differences between the two groups were not statistically significant (both P>0.05). The time of first pain and the time of the first pressing of the automatic analgesic device in combined group were (573±174) min and (962±313) min, which were significantly longer than those of control group [(13±6) min and (135±41) min] (both P<0.05). The dosage of remifentanil during operation and cumulative dosage of sufentanil at 24 h postoperatively in combined group were (410±129) μg and (14±4) μg, which were lower than those in control group [(580±225) μg and (21±11) μg] (both P<0.05). Cumulative dosage of sufentanil at 48 h postoperatively in combined group was (29±11) μg, while in control group was (36±14) μg, and the difference between the two groups was not statistically significant (P=0.131). The incidence of postoperative dizziness in combined group was 6.7% (1/15), which was lower than that of control group [40.0% (6/15)] (P=0.031). The incidence of nausea and pruritus was 6.7% (1/15) and 0 in combined group, while 20.0% (3/15) and 6.7% (1/15) in control group, with no statistical significance (both P>0.05). Conclusion: Serratus plane block combined with pectoral nerve block Ⅰ can effectively relieve postoperative pain, decrease the need for opioids, and reduce the incidence of adverse effects.
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Turkmen S, Mutlu M. Evaluation of the effect of different block techniques on open-heart surgery in the postoperative period: a prospective observational study. Cardiovasc J Afr 2022; 33:153-156. [PMID: 35333279 PMCID: PMC9540322 DOI: 10.5830/cvja-2022-016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/14/2022] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Open-heart surgery is associated with severe postoperative pain. Adequate analgesia after open-heart surgery improves patients' early postoperative recovery, extubation, ambulation and early discharge from hospital. Regional anaesthesia techniques are the new hope for adequate postoperative analgesia after cardiac surgery and are widely used for early pain management in the first six hours. METHODS A total of 100 patients with the American Society of Anesthesiologists physical status classification I-III, aged 18 years and over, undergoing open-heart surgery with sternotomy for coronary artery bypass grafting or valve replacement under general anaesthesia, were included in this study. For postoperative analgesia, 50 patients with pectoral nerve (PECS II) block and 50 with parasternal (PS) block were consecutively enrolled in one of the groups at the end of the surgery and compared in terms of sedation scores, ventilation duration, pain scores at rest after extubation, block duration, total morphine consumption and complications. RESULTS The block duration in the PS group was statistically significantly higher than in the PECS II group (p = 0.001, p < 0.05, respectively). The visual analogue scale scores at rest in the fourth and sixth hours were statistically significantly higher in the PECS II group than in the PS group ( p = 0.001, p = 0.001, p < 0.01). Cumulative morphine consumption in the PECS II group was statistically significantly higher than in the PS group in the fourth, sixth, 12th and 24th hours ( p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p < 0.01, respectively). CONCLUSIONS PS block provided longer block duration with lower postoperative pain and sedation scores than the PECS II block, with lower cumulative morphine consumption.
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Wongmek A, Parry M, Scully S. Sternal Gap Syndrome Caused by Improperly Fitted Body Armor: A Preventable Military Injury. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2022:82-84. [PMID: 34940973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Isolated atrophy of the pectoralis major muscle (PMM) secondary to traumatic lesion of the medial pectoral nerve is a known entity in the field of neuromuscular electrodiagnostics. Recent literature has begun describing a Pectoral Gap Phenomenon in which this atrophy occurs bilaterally as an overuse injury, leading to a marked concavity in the central chest wall musculature. While there is limited information in science journals on this topic, social media posts on weight lifting discuss the topic frequently. We report a case in which a soldier's body armor crushed the lateral medial and pectoral nerves against the anterior chest wall causing permanent upper body weakness. To optimize military medical readiness, awareness of this disorder and the pathophysiology causing it should spread so as to mitigate this potential for significant disability.
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Mendonça FT, Junior AVDAF, Nogueira HCR, Roncolato HH, Goveia CS. Efficacy of type-I and type-II pectoral nerve blocks (PECS I and II) in patients undergoing mastectomy: a prospective randomised clinical trial. Anaesthesiol Intensive Ther 2022; 54:302-309. [PMID: 36458667 PMCID: PMC10156554 DOI: 10.5114/ait.2022.121096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/22/2022] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION The benefits of type I/II pectoral nerve blocks (PECS I/II), which can be dose dependent, have been examined in different studies. Nonetheless, few randomised trials have been performed in South America. The present randomised trial examined the efficacy of PECS I/II with a higher dose of the local anaesthetic to manage perioperative pain after mastectomy in Brazil. MATERIAL AND METHODS This was a randomised, parallel, single-centre, and single-blind trial. Eighty participants undergoing elective mastectomy were randomised (1 : 1) to receive PECS I/II plus ultrasound-guided ropivacaine (0.5%) or standard general anaesthesia. The primary outcome was pain intensity at rest 24 hours after surgery, assessed with a numerical rating scale. Haemodynamic outcomes, consumption of opioids, anaesthe-tics and antiemetics, and post-anaesthetic recovery times were also recorded. RESULTS Sixty participants (75%) completed the study. The mean age was 54 years, with 57% of participants undergoing mastectomy and 43% undergoing quadrantectomy. Median pain intensity (interquartile range) at rest (24 h postoperatively) was lower in the PECS I/II group compared to the control group: 0 (0-1.75) vs. 1 (1-2), P = 0.021. A smaller number of patients in the PECS I/II group required intraoperative fentanyl (23.3% vs. 83.3%; P < 0.001) and postoperative tramadol (20.0 vs. 76.7%; P < 0.001). Mean doses of fentanyl and tramadol were about 4-5 times lower in the PECS I/II group (P < 0.001). PECS I/II significantly reduced sevoflurane consumption during surgery (P = 0.01). No difference was observed regarding adverse effects. CONCLUSIONS PECS I/II blockade with high-dose local anaesthetic is efficacious and safe, resulting in lower levels of perioperative pain after mastectomy compared to standard general anaesthesia.
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Elshanbary AA, Zaazouee MS, Darwish YB, Omran MJ, Elkilany AY, Abdo MS, Saadeldin AM, Elkady S, Nourelden AZ, Ragab KM. Efficacy and Safety of Pectoral Nerve Block (Pecs) Compared With Control, Paravertebral Block, Erector Spinae Plane Block, and Local Anesthesia in Patients Undergoing Breast Cancer Surgeries: A Systematic Review and Meta-analysis. Clin J Pain 2021; 37:925-939. [PMID: 34593675 DOI: 10.1097/ajp.0000000000000985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/05/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We aimed to compare the safety and efficacy of pectoral nerve block (Pecs) I and II with control or other techniques used during breast cancer surgeries such as local anesthesia, paravertebral block, and erector spinae plane block (ESPB). METHODS We searched 4 search engines (PubMed, Cochrane Library, Scopus, and Web of Science) for relevant trials, then extracted the data and combined them under random-effect model using Review Manager Software. RESULTS We found 47 studies, 37 of them were included in our meta-analysis. Regarding intraoperative opioid consumption, compared with control, a significant reduction was detected in Pecs II (standardized mean difference [SMD]=-1.75, 95% confidence interval [CI] [-2.66, -0.85], P=0.0001) and Pecs I combined with serratus plane block (SMD=-0.90, 95% CI [-1.37, -0.44], P=0.0002). Postoperative opioid consumption was significantly lowered in Pecs II (SMD=-2.28, 95% CI [-3.10, -1.46], P<0.00001) compared with control and Pecs II compared with ESPB (SMD=-1.75, 95% CI [-2.53, -0.98], P<0.00001). Furthermore, addition of dexmedetomidine to Pecs II significantly reduced postoperative opioid consumption compared with Pecs II alone (SMD=-1.33, 95% CI [-2.28, -0.38], P=0.006). CONCLUSION Pecs block is a safe and effective analgesic procedure during breast cancer surgeries. It shows lower intra and postoperative opioid consumption than ESPB, and reduces pain compared with control, paravertebral block, and local anesthesia, with better effect when combined with dexmedetomidine.
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Nadeau C, McGhee S, Gonzalez JM. Endometriosis: a guide to investigations and treatment in the emergency department. Emerg Nurse 2021; 30:e2110. [PMID: 34850614 DOI: 10.7748/en.2021.e2110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/09/2022]
Abstract
Endometriosis is an oestrogen-dependent disorder where endometrial tissue forms lesions outside the uterus, causing chronic inflammation and scarring. Women who have endometriosis may experience a highly variable range of non-specific signs and symptoms, including pelvic pain. Endometriosis is often misdiagnosed, partly because its signs and symptoms can easily be attributed to more common conditions that cause pelvic pain in women, resulting in delayed diagnosis and treatment. This article describes the pathophysiology, aetiology, risk factors for, and signs and symptoms of endometriosis. It also outlines how endometriosis should be investigated and treated in the emergency department (ED). Its aim is to support nurses to deliver effective care to women of reproductive age presenting to the ED with severe pelvic pain.
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Daniel Pereira D, Bleeker H, Malic C, Barrowman N, Shadrina A. Pectoral nerve block and acute pain management after breast reduction surgery in adolescent patients. Can J Anaesth 2021; 68:1574-1575. [PMID: 34081262 DOI: 10.1007/s12630-021-02037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022] Open
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Nadeau C, McGhee S, Gonzalez JM. Winged scapula: an overview of pathophysiology, diagnosis and management. Emerg Nurse 2021; 29:28-31. [PMID: 34159764 DOI: 10.7748/en.2021.e2090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/09/2022]
Abstract
Patients commonly present to the emergency department (ED) with shoulder injuries and shoulder pain. Winged scapula is one potential underlying cause of shoulder pain which is often forgotten or ill-defined. This non-traumatic skeletal condition typically presents as a prominent protrusion of the medial border of the bone from its normal position in the back. It often results from damage to and/or compression of the long thoracic nerve, which innervates the serratus anterior muscle. History taking, physical examination and imaging are needed to correctly diagnose winged scapula. Conservative management is often sufficient to resolve the condition. However, in some cases further investigations and more invasive treatment modalities are needed. This article provides an overview of the pathophysiology of winged scapula and its diagnosis and management in the ED.
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Lafosse T, D'Utruy A, El Hassan B, Grandjean A, Bouyer M, Masmejean E. Scapula alata: diagnosis and treatment by nerve surgery and tendon transfers. HAND SURGERY & REHABILITATION 2021; 41S:S44-S53. [PMID: 34246815 DOI: 10.1016/j.hansur.2020.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 04/16/2019] [Accepted: 09/20/2020] [Indexed: 11/17/2022]
Abstract
Scapula alata, also known as winged scapula, can lead to severe upper limb impairment. The shoulders' function is altered because the scapula, which supports the upper limb, is no longer stable. Typical scapula alata is described for serratus anterior palsy; however, any scapulothoracic muscle impairment may lead to scapular winging, particularly trapezius palsy, which is easy to miss, thus needed to be considered as a differential diagnosis. The diagnosis is difficult and based on various clinical tests and a thorough examination as well as electroneuromyography and MRI. The treatment ranges from conservative treatments for spontaneous recovery, nerve surgery including neurolysis, nerve transfers and nerve grafts for acute cases, to tendon transfers for more chronic cases and when nerve procedures are no longer feasible. Tendon transfers in serratus anterior palsy produce excellent results with a high rate of patient satisfaction and are described with the sternal or clavicular head of the pectoralis major; we describe our preferred technique in this article. Tendon transfers in trapezius palsy are performed with the levator scapulae, rhomboid minor and major muscles. Our preferred method is the Elhassan triple transfer. Scapula alata is a frequent and often misdiagnosed condition. Appropriate management can yield excellent results. Patients should be referred right away to specialized centers for surgery if recovery is not spontaneous.
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Kang S, Jeong HM, Kim BS, Yoon JS. Risk Analysis of Needle Injury to the Long Thoracic Nerve during Ultrasound-Guided C7 Selective Nerve Root Block. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:635. [PMID: 34205371 PMCID: PMC8235341 DOI: 10.3390/medicina57060635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Ultrasound (US)-guided cervical selective nerve root block (SNRB) is a widely used treatment for upper limb radicular pain. The long thoracic nerve (LTN) passes through the middle scalene muscle (MSM) at the C7 level. The needle trajectory of US-guided C7 SNRB pierces the MSM, therefore indicating a high probability of injury to the LTN. We aimed to identify the LTN and to investigate the risk of needle injury to the nerve during US-guided C7 SNRB. Materials and Methods: This retrospective observational study included 30 patients who underwent US-guided SNRB at the C7 level in a university hospital. We measured the maximal cross-sectional diameter (MCSD) of the LTN and cross-sectional area (CSA) of the C7 nerve root and assessed the injury risk of LTN during US-guided C7 SNRB by simulating the trajectory of the needle in the ultrasound image. Results: The LTN was detectable in all the cases, located inside and outside the MSM in 19 (63.3%) and 11 (36.7%) of cases, respectively. The LTN's mean MCSD was 2.10 mm (SD 0.13), and the C7 root's CSA was 10.78 mm2 (SD 1.05). The LTN location was within the simulated risk zone in 86.7% (26/30) of cases. Conclusion: Our findings suggest a high potential for LTN injury during US-guided C7 SNRB. The clear visualization of LTNs in the US images implies that US guidance may help avoid nerve damage and make the procedure safer. When performing US-guided C7 SNRB, physicians should take into consideration the location of the LTN.
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