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CUTANEOUS BRANCHES OF INTERCOSTAL NERVES BLOCK ASSOCIATED WITH PECTORAL NERVE BLOCK IN MASTECTOMIES: AN EFFECTIVE TECHNIQUE FOR PERIOPERATIVE PAIN CONTROL
Author(s): ,
Pérez Poquet, M.*
Affiliations:
Hospital Universitari Mútua Terrassa, Anesthesiology, Terrassa- Barcelona, Spain
,
Celdran Clusella, P.
Affiliations:
Hospital Universitari Mútua Terrassa, Anesthesiology, Terrassa- Barcelona, Spain
,
Alcántara Pinillos, P.
Affiliations:
Hospital Universitari Mútua Terrassa, Anesthesiology, Terrassa- Barcelona, Spain
Pérez Torrentó, C.
Affiliations:
Hospital Universitari Mútua Terrassa, Anesthesiology, Terrassa- Barcelona, Spain
ESRA Academy. Perez Poquet M. Sep 13, 2017; 190980; 343 Topic: REGIONAL ANAESTHESIA (RA) TECHNIQUES - CLINICAL IMPLICATIONS
Monica Perez Poquet
Monica Perez Poquet

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Abstract
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Background and Aims:

Ultrasound-guided block of the cutaneous branches of intercostal nerves associated with pectoral nerve block could be an effective technique for pain relief in mastectomies. The aim of this study is to evaluate the efficacy of this block reducing the perioperative pain. 

Methods:

We retrospectively analysed patients who underwent a mastectomy between 2014-2015. One group received the nerve block while the other group didn't. We used levobupivacaine 0.3%: 15 mL between pectoral minor and external intercostal muscles, 25 mL between serratus and external intercostal muscles and 10 mL between pectoral major and minor muscles. Perioperative dose of opioids and hospital stay were reported.

Results:

We included 47 patients. 19 without block (group A) and 28 with block (group B). Groups were similar in terms of age, weight and height. Differences between the intraoperative dose of fentanyl were observed (p=0.03). Group A received a mean of 0.73 mcg/Kg of fentanyl more than group B (IC 95%: 0.07-1.39). There were also statistically significant differences in the number of patients who needed morphine for postoperative pain control: Group A received morphine in 71% (n=10) of the patients and group B 29 % (n=4) (p=0.005). There were statistically significant differences between inpatient stay (p=0.003). Group A inpatient stay was a mean of 1.2 days longer more than those of group B (IC 95%: 0.4-1.9).

Conclusions:

The anterior and lateral branches of intercostal nerves block plus pectoral block are effective analgesic techniques in breast surgery. In our study, they reduced the opioid requirements and the inpatient stay on mastectomy.

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