Efficacy of Preoperative Pectoral Nerve Block for Intraoperative Opioid Sparing Effect and Postoperative Analgesia
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether pectoral nerves blocks（PECS） would reduces
      the opioid consumption during the surgery and postoperative pain after breast cancer surgery.
    

Detailed description: 
      Forty adult female participants scheduled for elective breast cancer surgery under general
      anesthesia are randomly allocated to receive either general anesthesia plus Pecs block(Pecs
      group, n=20) or general anesthesia alone (control group, n=20).

      After arrived in the operating room，all patients undergo operation under total intravenous
      anesthesia (TIVA) with or without pectoral nerves blocks(PECS) . After anesthesia
      induction，the participants in the Pecs group receive an ultrasound-guided Pecs block before
      the start of the operation.

      Pecs block technology：After cleaning the infraclavicular and axillary regions , the linear
      probe is placed below the lateral third of the clavicle. After recognition of the appropriate
      anatomical structures, then the block is performed . The needle is advanced to the tissue
      plane between the pectoralis major and pectoralis minor muscle at the vicinity of the
      pectoral branch of the acromiothoracic artery, and 10 mL of 0.5% ropivacaine deposited. In a
      similar manner, 20 mL is deposited at the level of the third rib between the pectoralis minor
      muscle and the serratus anterior muscle .

      During operation the remifentanil administration in each group is guided using the surgical
      pleth index( SPI). the SPI target range was 20 to 50 Anesthetic depth is maintained and
      continuously adjusted with propofol to achieve Bispectral Index (BIS) between 40 and 60.

      primary outcome intraoperative remifentanil consumption secondaty outcome postoperative pain
      score and rescue analgesic requirement
    

Intervention name(s): Pecs II block
Intervention type(s): Procedure
Intervention description(s): After identifying the axillary vein and artery, the ultrasound probe was positioned inferio-laterally, between the 3rd and 4th ribs, and then the pectoralis major and minor, and serratus anterior muscles were confirmed. The needle was advanced in a medio-lateral direction in-plane view of the ultrasound. For the Pecs II block, a total 30 mL of 0.5% ropivacaine was injected. First, the needle tip was advanced into the fascia between the pectoralis major and minor muscles and 10 mL of 0.5% ropivacaine was injected. Thereafter, the needle tip was advanced into the tissue plane between the pectoralis minor and serratus anterior muscles, and 20 mL of 0.5% ropivacaine was injected in a similar manner.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients either received the Pecs II block (Pecs group) or did not receive it (control group).
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Health Services Research