Effect of ultrasound-guided PecS II block on the incidence of chronic postmastectomy pain in patients after radical mastectomy: A randomized controlled trial.

Abstract

Background: The pectoral nerve (PecS) II block is a recently introduced technique utilized for surgical anesthesia and postoperative analgesia during breast surgery. This study aims to investigate the impact of ultrasound-guided PecS II block on the incidence of chronic postmastectomy pain in patients following radical mastectomy.

Methods: Ninety-eight patients undergoing selective radical mastectomy were included in this study. Based on whether the ultrasound-guided PecS II block was performed, the patients were randomly divided into the PecS II block group (group P) and the control group (group C). The primary outcomes included the incidence of chronic pain at 12 weeks after surgery, and the secondary outcomes included intraoperative dosage of remifentanil, the amount of oxycodone used in 48 h after surgery, time for the first analgesia administration, postoperative acute pain score 48 h after surgery, and HADS score at 48 h and 12 weeks after surgery. The presence or absence of pain in the previous week was recorded every 7 days after surgery (beginning on the 8^th day after surgery). The postoperative pain duration curves of the two groups were plotted and compared by Kaplan-Meier estimation and log-rank test.

Results: Compared with group C, the incidence of chronic pain in group P at 12 weeks after surgery was significantly decreased by 14.13% (20.65% vs. 34.78%, P < 0.05). The amount of remifentanil used in group P was significantly reduced (1.46 ± 0.11 mg vs. 2.66 ± 0.18 mg, P < 0.001), and the amount of oxycodone used 48 h after surgery in group P was remarkably reduced than that in group C (22.57 ± 3.21 mg vs. 31.62 ± 4.71 mg, P < 0.001). The first analgesic requirement time of group P was significantly longer than that of group C (368.80 ± 157.68 min vs. 96.60 ± 40.12 min, P < 0.001). Compared with group C, the postoperative acute pain score 48 h after surgery and the HADS score 48 h and 12 weeks after surgery in group P were significantly decreased (P < 0.05). The postoperative pain duration curve of the two groups was significantly different (P < 0.05), and the postoperative pain duration of group P was lower than that of group C (P < 0.05).

Conclusions: PecS II block can reduce the incidence of chronic postmastectomy pain after radical mastectomy, reduce perioperative opioid consumption, provide better analgesia, and improve the degree of anxiety and depression of patients.

Trial registration: ChiCTR2200066968, 22/12/2022.