Ismail, Abdul Jabbar
(2019)
Efficacy of ultrasound guided pectoral nerves block in patients undergoing unilateral breast surgery : a randomized controlled trial.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: PECS II Block is an alternative technique to Morphine for patients
undergoing unilateral breast surgeries as a part of multi-modal opioid-free postoperative
analgesia.
Objective: Assessment of efficacy and safety of PECS II Block against the routine use
of strong opioid Morphine in patients undergoing unilateral breast surgeries.
Methods: It was a randomized controlled clinical trial which had enrolled 60 patients
diagnosed with breast cancer stage I and II undergoing unilateral breast surgery with
axillary clearance. Participants were randomized into two treatment groups, one group
receiving PECS II block with Ropivacaine 0.375% and another group receiving IV
Morphine 0.1mg/kg prior to surgery. General Anaesthesia was administered throughout
the surgery for both groups of patients.
Results: Demographically, both groups were comparable in terms of age, height,
weight, BMI, pre-operative blood pressure and heart rate (p > 0.05). The average time
to perform PECS II Block was 17.7 (±7.72) minutes with no associated complications
encountered. In the controlled group, there were statistically significant lower intraoperative
systolic blood pressure (p = 0.03), and higher usage of intraoperative fentanyl
(p < 0.01) and phenylephrine (p = 0.04), however, the absolute difference was not
clinically significant. Although both groups show significant post-operative pain score
reduction in the first 24 hours (p < 0.01), there were no statistically significant
difference between the groups in terms of post-operative pain score (p = 0.51) and PCA
morphine usage (p = 0.86). However, patients receiving PECS II block had up to 50%
reduction in post-operative nausea and vomiting compared to the controlled group (p =
0.015).
Conclusion: PECS II Block is a safe technique and as effective as intravenous morphine
as an analgesic modality for unilateral breast surgery in addition to significantly
reducing PONV risk.
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