Comparison of Pre-op and Post-op Pectoralis Nerve Block
Condition: Breast Cancer; Postoperative Pain; Anesthesia; Nerve Block
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      The investigators will compare whether patients will have better pain control if they were to
      receive (PEC I/II block) before surgery or after mastectomy.
    

Detailed description: 
      The current standard of care at the University of Iowa is to receive a pectoralis nerve block
      (PEC I/II) prior to surgery for mastectomy and reconstruction cases. The investigators 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). The investigators 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, the investigators will have patients fill out
      forms to measure pain catastrophizing and depression and anxiety. The investigators 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 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. The investigators
      will also measure intraoperative and post-operative narcotic use (converted to morphine
      equivalents), post-operative nausea and vomiting, length of (PACU) stay. In addition the
      investigators will also 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.
    

Intervention name(s): PEC I/II blocks by anesthesiologist - pre-operative; PEC I/II blocks by surgeon - intra-operative
Intervention type(s): Procedure; Procedure
Intervention description(s): PEC I/II blocks by anesthesiologist - pre-operative; PEC I/II block to anesthetize the pectoral, intercostobrachial, third to sixth intercostal and long thoracic nerves. The PEC 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 (PEC II). Group I will have the PEC block administered by the anesthesiologist prior to surgical incision.; PEC I/II blocks by surgeon - intra-operative; PEC I/II block to anesthetize the pectoral, intercostobrachial, third to sixth intercostal and long thoracic nerves. The PEC 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 (PEC II).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: RANDOMIZED CONTROLLED DOUBLE BLIND STUDY
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Nerve block; Pectoralis nerve blocks; PECS I; PECS II; Mastectomy