Pectoral Nerve Block Type-II and Rhomboid Intercostal Block for Pain Management Following Mastectomy Surgery
Condition: Breast Cancer; Breast Neoplasms; Breast Diseases; Breast Fibroadenoma
MeSH terms: Breast Neoplasms; Fibroadenoma; Breast Diseases
Study type: Interventional

Summary: 
      Postoperative pain is an important issue in patients underwent mastectomy and axillary
      dissection surgery. Postoperative effective pain treatment provides early mobilization and
      shorter hospital stay. The US-guided pectoral nerve block (PECS) may be used for
      postoperative pain treatment following breast surgery. It is a novel interfascial block that
      was defined by Blanco. Rhomboid intercostal block (RIB) is a novel block and was first
      described by Elsharkawy et al. Local anesthetic solution is administrated between the
      rhomboid muscle and intercostal muscles over the T5-6 ribs. It has been reported that RIB may
      provide effective analgesia management for several breast surgeries.

      The primary aim of the study is to compare postoperative opioid consumption and the secondary
      aim is to evaluate postoperative pain scores (VAS), adverse effects related with opioids
      (allergic reaction, nausea, vomiting).
    

Detailed description: 
      Postoperative pain is an important issue in patients underwent mastectomy and axillary
      dissection surgery. Postoperative effective pain treatment provides early mobilization and
      shorter hospital stay, thus complications due to hospitalization such as infection and
      thromboembolism may be reduced.

      Various methods may be performed to reduce the use of systemic opioids and for effective pain
      treatment following mastectomy and axillary dissection surgery. Ultrasound (US)-guided
      interfascial plane blocks have been used increasingly due to the advantages of ultrasound in
      anesthesia practice. The US-guided pectoral nerve block (PECS) may be used for postoperative
      pain treatment following breast surgery. It is a novel interfascial block that was defined by
      Blanco. It is easy to perform; under ultrasound (US) guidance, the interfascial region
      between the pectoral muscles (pectoralis major (PMm) and minor (Pmm), serratus anterior Sam)
      is injected with local anaesthetics. It has been reported that PECS type-2 block provides
      effective analgesia management for mastectomy and axillary dissection surgeries.

      Rhomboid intercostal block (RIB) is a novel block and was first described by Elsharkawy et
      al. Local anesthetic solution is administrated between the rhomboid muscle and intercostal
      muscles over the T5-6 ribs 2-3 cm medially of the medial border of the scapula. RIB targets
      both the posterior rami and lateral cutaneous branches of the thoracic nerves and provides
      analgesia for the hemithorax from T2 to T9. It has been reported that RIB may provide
      effective analgesia management for several breast surgeries.

      The aim of this study is to evaluate the efficacy of the US-guided PECS-II and RIB for
      postoperative analgesia management compare to no intervention control group after mastectomy
      and axillary dissection surgery. The primary aim is to compare postoperative opioid
      consumption and the secondary aim is to evaluate postoperative pain scores (VAS), adverse
      effects related with opioids (allergic reaction, nausea, vomiting).
    

Intervention name(s): PECS block; Rhomboid intercostal block
Intervention type(s): Other; Other
Intervention description(s): A dose of ibuprofen 400 mgr and tramodol 100 mg will be performed intraoperatively. Patients will be administered ibuprofen 400 mgr IV every 8 hours in the postoperative period. A patient controlled device prepared with 10 mcg/ ml fentanyl will be attached to all patients with a protocol included 10 mcg bolus without infusion dose, 10 min lockout time and 4 hour limit.; A dose of ibuprofen 400 mgr and tramodol 100 mg will be performed intraoperatively. Patients will be administered ibuprofen 400 mgr IV every 8 hours in the postoperative period. A patient controlled device prepared with 10 mcg/ ml fentanyl will be attached to all patients with a protocol included 10 mcg bolus without infusion dose, 10 min lockout time and 4 hour limit.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: There are three models for this study. Patients will be randomly divided into three groups (Group P = PECS group, Group R = RIB group, Group C = Control group), before entering the operating room.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Mastectomy and axillary dissection surgery; Pectoral nerve block; Rhomboid intercostal block; Postoperative pain management