Adverse effect

Tramadol

Patient-controlled analgesia

Bupivacaine

Surgery

Receptor

Opioid

Anesthesia

Morphine

Ambulatory

Sedation

Levobupivacaine

Breast surgery

Mastectomy

Analgesic

Internal medicine

Prospective cohort study

Medicine

Breast cancer

Cancer

Randomized controlled trial

British Journal of Anaesthesia

BackgroundPectoral plane blocks (PECs) are increasingly used in analgesia for patients undergoing breast surgery, and were recently found to be at least equivalent to single-shot paravertebral anaesthesia. However, there are no data comparing PECs with the popular practice of continuous local anaesthetic wound infusion (LA infusion) analgesia for breast surgery. Therefore, we compared the efficacy and safety of PECs blocks with LA infusion, or a combination of both in patients undergoing non-ambulatory breast-cancer surgery.MethodsThis single-centre, prospective, randomised, double-blind trial analysed 45 women to receive either PECs blocks [levobupivacaine 0.25%, 10 ml PECs I and levobupivacaine 0.25%, 20 ml PECs II (PECs group); LA infusion catheter (levobupivacaine 0.1% at 10 ml h−1 for 24 h (LA infusion group); or both (PECs and LA infusion)]. The primary outcome measure was area under the curve of the pain verbal rating score whilst moving vs time (AUC) over 24 h. Secondary outcomes included total opioid consumption at 24 h.ResultsAUC moving was mean (SD) 71 (34) mm h−1 vs 58 (41) vs 23 (20) in PECs, LA infusion, and both, respectively; P=0.002. AUC at rest was also significantly lower in patients receiving both. The total 24 h opioid consumption [median (25–75%)] was 14 mg (9–26) vs 11 (8–24) vs 9 (5–11); P=0.4. No adverse events were observed.ConclusionsThe combination of both pre-incisional PECs blocks and postoperative LA infusion provides better analgesia over 24 h than either technique alone after non-ambulatory breast-cancer surgery.Clinical trial registrationNCT 03024697.

Single-shot pectoral plane (PECs I and PECs II) blocks versus continuous local anaesthetic infusion analgesia or both after non-ambulatory breast-cancer surgery: a prospective, randomised, double-blind trial