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Comparison Of Effectiveness Of Pre-incision Vs Post Incision Pecs Block In Pain Management In Breast Reconstruction Surgery: A Retrospective Cohort Study
Anshumi Desai, MD, Peter A. Borowsky, MD, Maria Mantero, BS, Chloe Shields, BS, Valeria Butos, MD MS MPH, Aris Arekelians, MD, Nicholas Mirsky, MD, Kristin E. Rojas, MD, Roby Weisman, MD, John Oeltjen, MD, Wrood Kassira, MD.
University of Miami, Miami, FL, USA.
PURPOSE: Pectoralis nerve block-type II (PECS II) reduces postoperative pain and opioid need in breast surgery. Traditionally administered preoperatively using ultrasound guidance, it can alternatively be performed intraoperatively. Our study assessed postoperative pain scores and opioid needs between patients receiving pre vs. post-incision PECS II
METHODS:A single-institution retrospective cohort study included patients undergoing mastectomy with reconstruction(Jan 2019-Dec 2021). Patients were divided as: pre-incision PECS II (PRE-PECS), vs post-incision PECS II (POST-PECS). The primary and secondary outcomes were postoperative pain score and opioid need (Oral-Morphine-Equivalents: OMEs) during admission.
RESULTS:Of 89 patients, 31 (35%) had PRE-PECS and 58 (65%) had POST-PECS. 111 PECS blocks (31 Unilateral and 58 Bilateral). Demographic and treatment characteristics were similar between cohorts. PRE-PECS patients had higher median maximum pain-scores during admission than POST-PECS (8 vs. 7; p= 0.046). First PACU and last recorded admission pain scores were similar. 4-hour postoperative OME use (PRE-PECS: 9.5 ± 12.1; POST-PECS: 11.2 ± 12.7; p= 0.323) and total admission OME use (PRE-PECS: 30.4 ± 28.7; POST-PECS: 25.2 ± 21; p= 0.618) were similar. Multivariate analysis controlling showed no association between PECS II type and postoperative pain score or OME.
CONCLUSION:POST-PECS provides similar pain control to PRE-PECS. Intraoperative regional blocks by the surgeon may be used when scheduling constraints prevent preoperative blocks or when specialized anesthesiologists are unavailable.
| | | | | | | | | |
| Univariate | Multivariate+ |
| | PRE-PECS | POST-PECS | p-value | OR | CI | p-value | OR | CI | p-value |
| First PACU pain score (median) | 0 | 0 | 0.572 | -0.04 | -1.05, 0.98 | 0.945 | 1.13 | -0.36, 2.61 | 0.137 |
| Highest pain score (median) | 8 | 7 | 0.046 | -0.15 | -0.92, 0.61 | 0.694 | -0.27 | -1.18, 0.63 | 0.555 |
| Last pain score (median) | 0 | 0 | 0.448 | -0.47 | -1.33, 0.39 | 0.283 | 0.55 | -0.50, 1.61 | 0.304 |
| OMEs at 4 hours (median) | 9.5 | 11.2 | 0.323 | 0.11 | -2.68, 8.06 | 0.323 | -0.14 | -9.54, 2.50 | 0.248 |
| OMEs during admission (median) | 30.4 | 25.2 | 0.618 | 0.10 | -5.42, 15.78 | 0.334 | 0.04 | -9.62, 13.64 | 0.732 |
+ BMI, stage, operative-time, mastectomy type, reconstruction-type, reconstruction-plane, laterality, local-anesthetic, axillary-management
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