The Impact of Pecs Blocks on Postmastectomy Pain Syndrome
Condition: Pain Syndrome; Pain, Postoperative; Chronic Pain; Breast Cancer; Breast Soft Tissue Neoplasm; Breast Neoplasms; Breast Cancer Female; Breast Pain; Anesthesia
MeSH terms: Breast Neoplasms; Neoplasms; Soft Tissue Neoplasms; Syndrome; Chronic Pain; Pain, Postoperative; Mastodynia
Study type: Interventional

Summary: 
      The aim of the present study is to investigate the incidence of chronic pain following breast
      cancer surgery in Cyprus, discover its associated risk factors and explore the impact of Pecs
      Blocks on the appearance of post mastectomy chronic pain symptoms
    

Detailed description: 
      Breast cancer is the commonest type of malignancy in women. Chronic postoperative neuropathic
      pain may appear either in the early postoperative period or at a later stage, usually 3-6
      months post-operatively. Chronic post-operative pain syndrome of any magnitude usually
      involves 19-57% of patients that have undergone any kind of surgical procedure, while 5% of
      them experience intense symptoms. Risk factors for developing post-mastectomy pain syndrome
      include younger age, increased Body mass Index (BMI), psychological profile, co-existence of
      other painful conditions, pre-operative radiotherapy/chemotherapy, type of surgical procedure
      and anaesthesia, persistent acute postoperative pain, etc. Consequently, chronic post
      mastectomy pain syndrome results in significant psychosomatic sequelae with variable social
      impacts for the female patients.

      The aim of the present study will be to investigate the incidence of chronic pain following
      breast cancer surgery in Cyprus, discover its associated risk factors and explore the impact
      of Pecs Blocks on the appearance of post mastectomy chronic pain symptoms.

      During the preoperative visit, the women will be informed about the study and will be
      instructed to the use of the pain numeric rating scale (NRS) graded from 0 to 10.
      Standardized anesthesia will be administered. All patients will receive 1000 mg of
      paracetamol and 0.07 mg/ Kg of morphine intraoperatively. In the Post-Anesthesia Care Unit
      (PACU), patients will receive additional morphine boluses on request, until NRS score is
      lesser or equal than 4. Postoperative nausea and vomiting will be treated with ondansetron 4
      mg iv. After discharge from PACU, patients will receive a combination of paracetamol 1 gr/6h
      and im pethidine 75 mg on request, as per hospital protocol.

      Numerical rating scores (NRS) at rest and movement will be measured at 6h, 12h and 24h
      postoperatively. Additionally, the time to first request for analgesia after surgery will be
      noted.

      All patients will also be evaluated 3 and 6 months after surgery with the use of NRS at rest
      and movement and additionally, via the use of Douleur Neuropathique (DN4) questionnaire for
      the occurence of neuropathic pain.
    

Intervention name(s): Pecs block; no Pecs block
Intervention type(s): Other; Other
Intervention description(s): Pecs block under real-time ultrasound guidance after anesthesia induction will be performed.; no regional block will be performed in this arm
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention