Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Ultrasound-guided pectoral nerve block for pain control after breast augmentation: a randomized clinical study

Bahadır Ciftci, Mursel Ekinci, Erkan Cem Celik, Pelin Karaaslan, Ismail Cem Tukac

Downloads: 0
Views: 32


Background and objective
Pectoral nNerve (PECS) block type-1 is an Ultrasound (US)-guided interfacial block that can be performed for postoperative analgesia management after breast surgery. In the procedure, a local anesthetic solution is injected into the interfacial area between the Pectoralis Major muscles (PMm) and Pectoralis minor muscles (Pmm). The present study compared PECS block type-1 administered preoperatively or postoperatively for postoperative analgesia after breast augmentation surgery.

The patients were randomly divided into three groups (n = 30 in each): a preoperative PECS block group (Pregroup), postoperative PECS block group (Postgroup), and control group (Group C). Opioid consumption and Visual Analogue Scale (VAS) scores were evaluated at postoperative period.

The pains scores in the Pregroup were significantly lower than those in the control group. Although there was no significantly difference in the VAS scores of the Postgroup and control group at postoperative 1 h, the scores in the Postgroup were significantly lower than those in the control group at all the other evaluated times (p < 0.05). The VAS scores in the Pregroup were significantly lower than those in the Postgroup 8 h after the surgery. Opioid consumption was significantly lower in the Pregroup as compared with that in the other two groups (p < 0.05). The use of rescue analgesia in the Pregroup was significantly lower than that in the other groups (p < 0.05).

Performing PECS block type-1 preoperatively reduced VAS scores and opioid consumption after breast augmentation.


Breast augmentation surgery;  Regional analgesia;  Pectoral nerve block type-1


1 Cm McCarthy, Sj Cano, Af Klassen, et al. The magnitude of effect of cosmetic breast augmentation on patient satisfaction and health-related quality of life Plastic and reconstructive surgery, 130 (2012), pp. 218-223

2 M.L. Von Sperlingl, H. Høimyrl, K. Finnerupl, et al. Persistent pain, and sensory changes following cosmetic breast augmentation Eur J Pain., 15 (2011), pp. 328-332

3 R. Buenaventura, R. Adlaka, N. Sehgal Opioid complications and side effects Pain Physician., 11 (2008), pp. 105-120

4 S.S. Stanley, I.C. Hoppe, F.S. Ciminello Pain control following breast augmentation: a qualitative systematic review Aesthetic Surg J., 32 (2012), pp. 964-972

5 R. Blanco The ‘pecs block’: a novel technique for providing analgesia after breast surgery Anaesthesia., 66 (2011), pp. 847-848

6 C.M. Kang, W.J. Kim, S.H. Yoon, et al. Postoperative pain control by intercostal nerve block after augmentation mammoplasty Aesthet Plast Surg., 41 (2017), pp. 1031-1036

7 M. Fayman, A. Beeton, E. Potgieter, et al. Comparative analysis of bupivacaine and ropivacaine for infiltration analgesia for bilateral breast surgery Aesthetic Plast Surg., 27 (2003), pp. 100-103

8 P. Tan, M.S. Martin, N. Shank, et al. A comparison of 4 analgesic regimens for acute postoperative pain control in breast augmentation patients Annals Plast Surg., 78 (6S suppl 5) (2017), pp. S299-S304

9 S. Gardiner, G. Rudkin, R. Cooter, et al. Paravertebral blockade for day-case breast augmentation: a randomized clinical trial Anesth Analg., 115 (2012), pp. 1053-1059

10 SS Wahba, SM Kamal Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery Egypt J Anaesth., 30 (2014), pp. 129-135

11 S. Kulhari, N. Bharti, I. Bala, et al. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial Brit J Anaesth., 117 (2016), pp. 382-386

12 GMN Bashandy, DN Abbas Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial Reg Anesth Pain Med., 40 (2015), pp. 68-74

13 H Morioka, Y Kamiya, T Yoshida, et al. Pectoral nerve block combined with general anesthesia for breast cancer surgery: a retrospective comparison JA clinical reports., 1 (2015), p. 15

14 O. Karaca, H.U. Pınar, E. Arpacı, et al. The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: A prospective, randomised study Anaesth Crit Care Pain Med., 38 (2019), pp. 47-52

15 R. Benyamin, A.M. Trescot, S. Datta, et al. Opioid complications, and side effects Pain Physician., 11 (2 Suppl l) (2008), p. S105

16 A. Gago Martinez, B. Escontrela Rodriguez, A. Planas Roca, et al. Intravenous ibuprofen for treatment of post-operative pain: a multicenter, double blind, placebo controlled, randomized clinical trial PLoS One., 11 (2016), Article e0154004

17 A Buvanendran, JS Kroin Multimodal analgesia for controlling acute postoperative pain CurrOpinAnaesthesiol., 22 (2009), pp. 588-593

18 J. Cros, P. Sengès, S. Kaprelian, et al. Pectoral I block does not improve postoperative analgesia after breast cancer surgery: A randomized, double-blind, dual-centered controlled trial Reg Anesth Pain Med., 43 (2018), pp. 596-604

19 F. Lakdja, F. Dixmérias, E. Bussières, et al. Preemptive analgesia on postmastectomy pain syndrom with ibuprofen-arginine Bulletin Du Cancer, 84 (1997), pp. 259-263

20 D.J. Kelly, M. Ahmad, S.J. Brull Preemptive analgesia I: physiological pathways and pharmacological modalities Can J Anesth, 48 (10) (2001), pp. 1000-1010

21 J. Zielinski, R. Jaworski, I Smietanska, et al. A randomized, double-blind, placebo-controlled trial of preemptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast Med Sci Monit., 17 (2011) CR589-97

600875780e88250849345c1b rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections