Comparison of Perioperative Opioid Consumption Following Pectoral Nerve Block for Breast Cancer Surgery

Study Overview
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Brief Summary
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In this study, the investigators will compare the intraoperative opioid consumption for patients undergoing breast cancer surgery. The patients will be divided in two groups, the first one will receive a pectoral nerve block right after induction of anesthesia and the second one, the control group, will not receive the pectoral block. Our hypothesis is that the pectoral nerve block reduces the opioid consumption during the surgery.

Detailed Description
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After induction of general anesthesia with propofol, remifentanil and succinylcholine, the patients will be divided either in the pectoral block group or the control group (sham block). Both groups will receive the same perioperative and postoperative anesthetic protocol. The investigator in charge of the patient will leave the operative room right before the completion of the pectoral block (or the sham block) to preserve randomisation and the block will be performed by another investigator. The pectoral block is performed under ultrasound guidance with 10 cc of lidocaine 1% with epinephrine 1/400000 between the pectoralis major muscle and the pectoralis minor muscle and 20 cc of the same solution between the pectoralis minor muscle and the serratus anterior muscle at the third rib. Anesthesia will be maintained with sevoflurane for a bispectral (BIS) index between 45 and 60. Analgesia will be provided with a perfusion of remifentanil adjusted to maintain a mean arterial blood pressure (MAP) in the range of ± 10% of the basal MAP (mean of the last three MAPs obtained before surgical incision, under sevoflurane-only anesthesia). The total remifentanil consumption will be assessed and compared between the groups. The investigators believe that the pectoral nerve block will significantly reduce the intraoperative remifentanil consumption.

Official Title
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Comparison of Perioperative Opioid Consumption Following Pectoral Nerve Block Under General Anesthesia for Breast Cancer Surgery: A Randomized Clinical Trial

Conditions
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Nerve Block, Mastectomy

Intervention / Treatment
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* Drug: Lidocaine 1% with epinephrine 1/400000
* Other: sham block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA 1 to 3 inclusively breast cancer surgery with or without axillary dissection Exclusion Criteria: any contraindication to the pectoral nerve block (coagulopathy, infection, pre- existing neuropathy, local anesthetic allergy and refusal of local anesthesia) refusal to participate in the study patient with dementia preoperative breast pain preoperative opioid consumption breast reconstructive surgery bilateral surgery pregnant patient

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Pectoral nerve block<br>After induction of general anesthesia and under ultrasound visual guidance, pectoral block is performed with 30 mL total of local anesthetic (1% lidocaine + 1/400000 epinephrine). 10 mL of local anesthetic between pectoralis major muscle and pectoralis minor muscle and 20 mL between pectoralis minor muscle and serratus anterior muscle at the third rib. | Drug: Lidocaine 1% with epinephrine 1/400000<br> <br> * Other names: xylocaine with epinephrine;|
| Sham Comparator: Sham block<br>No needle or injection will be used | Other: sham block<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative remifentanil consumption for the first 30 minutes of surgery |  | 30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total intraoperative remifentanil consumption |  | 2 hours | 
| Total intraoperative sevoflurane consumption |  | 2 hours | 
| Postoperative pain evaluation | using the numerical rating scale | 30 minutes | 
| Postoperative nausea and vomiting evaluation |  | 30 minutes | 
| Total time in the recovery room |  | 60 minutes | 
| Postoperative opioid consumption | dilaudid consumption | 1 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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analgesics, opioids, pectoral block