Analgesia Efficacy of Pre-operative and Post-operative PEC I/II Block for Bilateral Mastectomy With Reconstruction
Phase: NA
Conditions: Breast Cancer, Postoperative Pain, Anesthesia, Nerve Block
Sponsor: Melinda Seering

Randomized Double Blinded Study Comparing Timing of PEC Block 
for Post-Operative Pain in Bilateral Mastectomy Patients 
 
 
NCT Number:  03653988 
 
Melinda Seering, MD 
Document Date:  October 3, 2018 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
The current standard of care at the University of Iowa is to receive a pectoralis nerve 
block PEC I/II block prior to surgery for mastectomy and reconstruction cases. We will 
compare whether patients will have better pain control if they were to receive (PEC I/II 
block) before surgery or after the mastectomy. Patients undergoing mastectomies at the 
University of Iowa Hospitals clinics receive general anesthesia and a regional block for 
pain control. The most commonly employed regional anesthetic technique is a PECS I/II 
block to anesthetize the pectoral, intercostobrachial, third to sixth intercostal and long 
thoracic nerves. The PECS I/II blocks are pectoralis field blocks where local anesthetic 
medication is injected under ultrasound guidance between the tissue planes of 
pectoralis major and minor muscles (PECS I) and in the plane of the serratus anterior 
muscle at the level of the third rib (PECS II). We will randomize patients into two groups 
and blind the patient and the research assistant collecting the data. Group I will have 
the block performed after induction of general anesthesia and prior to surgical incision 
by the anesthesiologist. Group II will have the block administered by the surgeon after 
mastectomy is performed and before reconstruction. On the day of surgery, we will have 
patients fill out forms to measure pain catastrophizing and depression and anxiety. We 
would like to measure if there is any difference in postoperative pain scores (visual 
analogue scale)-immediately post-surgery in post-anesthesia care unit(PACU), and then 
on the admission unit every 4 hours for the first twenty four hours or on discharge 
(whichever time-point occurs sooner) and we will collect the average pain scale of the 
day on post-op day (POD) 2,3,5 and 7 via patient communication electronic message in 
RedCap. We will also measure intraoperative and post-operative narcotic use 
(converted to morphine equivalents), post-operative nausea and vomiting, length of 
(PACU) stay. In addition, we will collect pain scores and pain catastrophic scale on POD 
14 after surgery at their clinic visits to the surgeon. Other data collected will include time 
taken to perform block, post-operative infection rate and post-operative flap necrosis 
rate.