The Effects of Perioperative PECS Block During Robotic Breast Surgery and Breast Reconstruction

Study Overview
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Brief Summary
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Pectoral nerve blocks (PECS blok) are used in postoperative analgesia after breast surgery in nowadays. Many studies shows that pectoral nerve blocks is effective for reducing pain and postoperative opioid consumption undergoing mastectomy. This study was planned to evaluate the efficacy of intraoperative PECS block for postoperative analgesia after robot breast surgery and immediate breast reconstruction.

Detailed Description
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Sixty patients were randomly allocated into two groups by computerised process, each including 30 patients. PECS group (P) received general anesthesia and pectoral nerve block(PECS block) with 025% ropivacaine after surgical resection of breast by operator. Control group(C) only received general anesthesia. A Patient -controlled analgesia(PCA) device provides fentanyl for postoperative pain control. The Primary outcome measures total dose of fentanyl consumption during the postoperative 24 hours, and secondary outcome measures pain scores at rest and movement.

Official Title
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The Effects of Perioperative PECS Block on Postoperative Pain Control During Robotic Breast Surgery and Breast Reconstruction - Double Blind Randomized Controlled Trial -

Conditions
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Breast Neoplasm

Intervention / Treatment
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* Procedure: pectoral nerve block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 20years or older Scheduled for robot-assisted nipple-sparing mastectomy with immediate gel implant or tissue expander breast reconstruction American Society of Anesthesiologists(ASA) physical status I and III Exclusion Criteria: Emergency operation Reoperation Patients with local anesthetic allergy Patients with coagulopathy Patients on anticoagulants Patients who cannot use patient controlled analgesia(PCA) Patients with morbid obesity [body mass index (BMI) >35 kg/m2] Patients with history of uncontrolled hypertension (diastolic BP >110mmHg) or DM Patients with history of heart failure (unstable angina, congestive heart failure) Patients with history of liver failure, renal failure, allergic to medicine Patients with history of cerebrovascular disease (cerebral hemorrhage, cerebral ischemia) Patients with history of uncontrolled psychiatric disease (PTSD, anxiety, depression) Patients who cannot read the consent form (examples: Illiterate, foreigner) Patients who withdraw the consent

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PECS block(P) group<br>PECS group (P) received general anesthesia and pectoral nerve block(PECS block) with 025% ropivacaine after surgical resection of breast by operator. | Procedure: pectoral nerve block<br>* Patients received standardized general anesthesia. PECS block were applied under vision using blunted tip cannula(27G, 30mm) after surgical resection of breast by operator. 0.25% ropivacaine 10ml was injected into fascia between pectoralis major and minor muscles. 0.25% ropivacaine 20ml was injected into fascia between pectoralis minor and serratus anterior muscles at the level of the third rib. Breast reconstruction is performed after PECS block<br>|
| No Intervention: Control(c) group<br>only received general anesthesia | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total dose of fentanyl consumption during the postoperative 24h | To evaluate the effect of PECS block undergoing robot-assisted nipple-sparing mastectomy (RANSM) with immediate breast reconstruction (IBR), total cumulative dose of fentanyl was measured for the first postoperative 24h | after 24 hours postoperative period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 0 hour after surgery | 
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 0.5 hour after surgery | 
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 1 hour after surgery | 
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 2 hours after surgery | 
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 4 hours after surgery | 
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 6 hours after surgery | 
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 8 hours after surgery | 
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 12 hours after surgery | 
| a numeric rating score at rest | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 24 hours after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 0 hour after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 0.5 hour after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 1 hour after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 2 hours after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 4 hours after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 6 hours after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 8 hours after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 12 hours after surgery | 
| a numeric rating score at movement | Secondary outcome measures were postoperative pain using numeric rating score (NRS, 0-10; 0=no pain and 10=worst imaginable pain) | 24 hours after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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breast neoplasms