Post-Operative Analgesia and Enhanced Recovery after Pecs 1 and Pecs 2 Blocks in Patients Undergoing Modified Radical Mastectomy/Breast-Conserving Surgery with Axillary Lymph Nodal Clearance

Abstract

Background Patients undergoing modified radical mastectomy (MRM)/breast-conserving surgery (BCS) with axillary nodal clearance experience significant post-operative pain, resulting in immobilization and increased usage of analgesics. These factors in turn result in delayed discharge. The pecs 1 and pecs 2 blocks have proven to be of significant benefit in relieving post-operative pain in such patients. [1–7] Objectives A case series was performed at our institute to note the effects of pecs 1 and pecs 2 blocks on post-operative opioid use, early mobilization of the upper limbs, decreased incidence of early post-operative limb swelling and enhanced recovery after surgery. Material and Methods We included six patients who underwent BCS with axillary lymph node dissection/MRM wherein intraoperative pecs 1 and pecs 2 blocks were used. Patients were given pecs 1 and 2 blocks with 10+20 mL 0.25% injection of bupivacaine under ultrasound guidance after induction. Only patients who were American society of anesthesiologists (ASA) class [8] 1 and 2 pre-operatively were included in the study. Results In our study, opioids were completely avoided and it was seen that post-operative pain was adequately controlled with single doses of non-steroidal anti-inflammatory drugs if patients received intra-operative pecs 1 and 2 blocks. The pain control was rather sustained and adequate for the institution of early post-operative physiotherapy and thus early discharge and enhancing recovery after surgery. Conclusion Post-operative analgesia provided by pecs 1 and 2 blocks resulted in adequate and sustained pain control for early institution of upper limb physiotherapy and mobilization of patients after MRM/BCS with axillary lymph node dissection, which subsequently results in decreased incidence of early post-operative oedema of limb on operated side and early recovery after surgery.