The PECS I and PECS II blocks, which are advanced ultrasound-guided regional anesthesia methods, offer effective analgesia for the thoracic and abdominal wall. This review was prompted by our keen interest in understanding the prevalent use of these blocks for postoperative pain management in breast surgery patients, and it synthesizes the research findings that elucidate their frequent application in clinical practice.
The Pectoral (PECS) Regional Block:
A Scoping Review
This review included 15 articles published in English between 2010 and September 2022 that involved adult patients undergoing breast surgery with PECS regional block as the primary modality of anesthesia or as part of the postoperative analgesia plan were included in the scoping review.
Key Takeaways:
Breast surgery, a common medical procedure worldwide, often leaves patients grappling with significant postoperative pain. This pain, if poorly managed, can lead to chronic discomfort, psychological trauma, and delayed recovery In recent years, the Pectoral (PECS) regional block has emerged as a promising technique to alleviate pain associated with breast surgeries.
The PECS block, an interfacial plane block, targets the deep fascial planes of the chest, offering a potential space for injecting local anesthetics. The technique involves two types of blocks: PECS I and PECS II. PECS I is the injection of anesthetics between the pectoralis major and minor muscles, while PECS II includes an additional deeper injection between the pectoralis minor and the serratus anterior muscle.
A scoping review using Arksey and O’Malley's framework, as described by Levac, was conducted to evaluate the effectiveness of the PECS block. The review aimed to answer several key questions regarding the use of the PECS block in breast surgeries, its efficacy in pain management, and the types of local anesthetics used.
Reduced Opioid Consumption and Improved Pain Management
The review revealed that the PECS block significantly reduced intraoperative opioid consumption in 60% of the cases and postoperative opioid consumption in 93.3% of the cases. This is a crucial finding, considering the current opioid crisis and the need for alternative pain management strategies.
Local Anesthetics and Techniques
Various local anesthetics were employed in the studies, including ropivacaine, bupivacaine, and levobupivacaine. The review highlighted the need for further research to determine the optimal type, concentration, and volume of local anesthetic for the PECS block.
Patient Satisfaction and Quality of Recovery
Patients who received the PECS block reported lower pain scores and a decrease in the incidence of nausea and vomiting, leading to overall higher satisfaction compared to those who received systemic analgesia. This suggests that the PECS block could be a valuable addition to the pain management protocol for breast surgeries.
Conclusion
The scoping review underscores the potential of the PECS block as an effective pain management technique for breast surgeries. It offers a decrease in opioid consumption, improved patient comfort, and a reduction in postoperative complications. As the medical community continues to seek better pain management solutions, the PECS block stands out as a promising option for patients undergoing breast surgeries.
This review summarizes the key findings, emphasizing the benefits of the PECS block in breast surgery. It provides a glimpse into the potential improvements in patient care and pain management that this technique offers. For more detailed information and a deeper dive into the research, readers are encouraged to refer to the full review.
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Source:
Monitoring Editor: Alexander Muacevic and John R AdlerKhalid Bin Ghali, Nourah AlKharraz, Omar Almisnid, Adel Alqarni, Omar A Alyamani1
Cureus. 2023 Oct; 15(10): e46594.
Related Blog: The Four Blocks of the Chest: A Comprehensive Guide
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