PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study
PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study
Jean Desroches, Maxim Roy, Marc Belliveau, Benoit Leblanc, Pierre Beaulieu
Abstract
Background and objectives
PECS I block was first described for surgery involving the pectoralis muscles. No randomized clinical trial has been conducted on surgeries that directly involve these muscles, such as subpectoral breast augmentation. We hypothesized that PECS I block would decrease pain in the postoperative period in this population.
Methods
This was a randomized, double-blind, placebo-controlled trial in women undergoing subpectoral breast augmentation surgery. PECS I block was performed using 0.4 mL.kg-1 of 0.9% saline on one side and bupivacaine (0.25%) on the other side, each patient being her own control. Numeric Rating Scale (NRS) pain scores (0 − 10) were measured at rest and during movement. The primary outcome was pain score at rest 30 minutes after arrival in the PACU. To detect a clinically significant difference of 50% in pain reduction, 14 volunteers were enrolled (power of 90% and alpha < 0.05).
Results
In the PACU, three patients had no difference in pain between sides, five had reduced pain on the placebo side, and six had reduced pain on the bupivacaine side. In the bupivacaine group, pain scores at rest at 5, 30 and 60 minutes and 24 hours were 4.89 (4.23 − 5.56; mean 95% CI), 3.75 (3.13 − 4.37), 3.79 (2.93 − 4.64), and 2.29 (1.56 − 3.01), respectively, whereas in the placebo group, they were 4.96 (4.32 − 5.60), 4.00 (3.50 − 4.49), 3.93 (3.12 − 4.73), and 2.29 (1.56 − 3.01), respectively.
Conclusions
PECS I block in patients undergoing breast augmentation surgery does not provide better pain relief than placebo. Therefore, the indications for PECS I block in breast augmentation surgery should be reconsidered.
Keywords
Resumo
Justificativa e objetivos
O bloqueio PECS I foi descrito pela primeira vez para cirurgia envolvendo os músculos peitorais. Nenhum estudo clínico randomizado foi realizado em procedimentos envolvendo diretamente os músculos peitorais, como a mamoplastia de aumento submuscular. Nossa hipótese foi de que o bloqueio PECS I diminuiria a dor pós-operatória nessa população.
Método
Realizamos estudo randomizado, duplo-cego, controlado por placebo em mulheres submetidas à mamoplastia de aumento submuscular. Realizamos o bloqueio PECS I com 0,4 mL.kg-1 de solução salina a 0,9% de um lado e bupivacaína (0,25%) do outro lado, sendo cada paciente seu próprio controle. Os escores da Escala de Avaliação Numérica (EAN) de dor (0 − 10) foram obtidos em repouso e durante movimento. O desfecho primário foi o escore de dor em repouso 30 minutos após a chegada à SRPA. Para detectar uma diferença clinicamente significante de 50% na redução da dor, 14 voluntárias foram incluídas (poder de 90% e alfa < 0,05).
Resultados
Na SRPA, três pacientes não apresentaram diferença na dor entre os lados, cinco relataram menos dor no lado do placebo, e seis menos dor no lado da bupivacaína. No grupo bupivacaína, os escores de dor em repouso aos 5, 30 e 60 minutos e 24 horas foram 4,89 (4,23 − 5,56; IC médio 95%), 3,75 (3,13 − 4,37), 3,79 (2,93 − 4,64) e 2,29 (1,56 − 3,01), respectivamente, enquanto no grupo placebo foram 4,96 (4,32 − 5,60), 4,00 (3,50 − 4,49), 3,93 (3,12 − 4,73) e 2,29 (1,56 − 3,01), respectivamente.
Conclusões
O bloqueio PECS I em pacientes submetidas à mamoplastia de aumento não oferece melhor alívio da dor do que o placebo. Portanto, as indicações para bloqueio de PECS I na cirurgia de aumento de mama devem ser reconsideradas.
Palavras-chave
References
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Submitted date:
05/08/2019
Accepted date:
04/14/2020
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