ESRA Academy. Versyck B. Sep 8, 2016; 138319; 0148 Topic: Peripheral Nerve Blocks
Dr. Barbara Versyck
Dr. Barbara Versyck

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Background and Aims:

The pectoral nerves block type II (Pecs), as described by Blanco et al., is a superficial and easy regional anesthesia technique that blocks at least the pectoral, intercostobrachial, III-VI intercostals, and the long thoracic nerves which may provide effective pain relief after breast surgery. In this prospective randomized double blind placebo-controlled study, we hypothesized that adding the Pecs block to the anesthetic procedure reduces opioid consumption during and after surgery while maintaining or reducing pain levels.


After receiving approval of the local ethics committee, we randomized 140 breast cancer stage 1-3 patients undergoing mastectomy or tumorectomy with sentinel node or axillary node dissection. Surgery was performed under general anesthesia combined with either a Pecs block (levobupivacaine 0.25%) or placebo block (NaCl 0.9%). Our co-primary outcome measures were the Numeric Rating Scale pain scores and peroperative and postoperative opioid consumption.Ethics Committee Approval


Patients receiving the Pecs block reported similar or lower Numeric Rating Scale pain scores compared to the placebo group. No difference in peroperative opioid consumption was demonstrated. However, patients in the Pecs group consumed significantly less postoperative opioids (39% or 5.8 mg morphine equivalent). Moreover patients receiving the Pecs block experienced less pain peaks and were highly satisfied about their pain management.


The Pecs block provides reliable and effective analgesia. It significantly reduces postsurgical opioid consumption and provides adequate and consistent pain relief for patients undergoing breast cancer surgery.

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