Comparing the QoR of PECS Block and GA in Breast-conserving Surgery With Sentinel Lymph Node Biopsy

Study Overview
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Brief Summary
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The aim of this randomized controlled trial (RCT) is to assess the Quality of Recovery (QoR) in Breast-conserving Surgery (BCS) with Sentinel Lymph Node Biopsy (SLNB) using Pectoral Nerves (PECS) Block and General Anesthesia (GA). The primary objectives are as follows: First, to determine if the PECS group exhibits better QoR; Second, to investigate if the PECS group experiences less postoperative pain and complications; Third, to examine if the PECS group demonstrates more stable hemodynamics.

Detailed Description
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This study is a randomized controlled trial, with a 1:1 ratio for grouping. The experimental group is the T group, receiving Pecs II combined with intercostal nerve block, while the control group is the C group, receiving general anesthesia. The primary outcome measure is the QoR-15 score of the subjects 6 hours after surgery. Based on preliminary results, the control group had a QoR-15 score of 133±8 (n=6), and the experimental group needs to improve by at least 8 points (which is generally considered clinically significant, PMID:27159009). With a two-sided α=0.05 and a power of 99%, accounting for a 20% dropout rate, the final required sample size was calculated to be 96 cases, with 48 cases in each group. If the proportion of dropout cases is less than 5% and considered completely random missing, the missing records generated by the dropout cases will be directly excluded. Depending on the specific circumstances, either single imputation or multiple imputation methods will be used.

Official Title
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Comparing the Quality of Recovery(QoR) of Pectoral Nerves(PECS) Block and General Anesthesia(GA) in Breast-conserving Surgery(BCS) With Sentinel Lymph Node Biopsy(SLNB):A Randomized Controlled Trial

Conditions
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Breast Cancer, Pectoral Nerves Block, Breast-Conserving Surgery, Sentinel Lymph Node Biopsy

Intervention / Treatment
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* Combination Product: PECS II combined with intercostal nerve blockade;
* Combination Product: General anesthesia with laryngeal mask


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for breast-conserving surgery with sentinel lymph node biopsy. Age between 18 and 70 years. Body Mass Index (BMI) < 30 kg/m2. American Society of Anesthesiologists (ASA) classification grade I-III. Exclusion Criteria: Contraindications to regional anesthesia: site infection at the puncture site, allergy to local anesthetics, coagulation disorders, or bleeding risks. Impaired liver or kidney function. Pregnancy, lactation, possibility of pregnancy, or planned pregnancy. Preoperative use of analgesic drugs, history of chronic pain, or history of opioid abuse. Mental illness. Patients who refuse to participate. Patients deemed unsuitable for the clinical trial by the researchers.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 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
Interventional Model Description: The nerve block group was named the test group (T Group), and the laryngeal mask general anesthesia group was named the control group (C Group). The T Group received PECS II combined with intercostal nerve blockade, while the C Group underwent laryngeal mask insertion after general anesthesia induction.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: T Group<br>The T Group received PECS II(PMID: 22939099) combined with intercostal nerve block | Combination Product: PECS II combined with intercostal nerve blockade;<br>* The patient was in a supine position, and under ultrasound guidance, the needle tip was first placed in the plane between the pectoralis major and minor muscles, and 10ml of 0.3% ropivacaine was injected. The needle was then advanced into the space between the pectoralis minor and serratus anterior muscles, and 20ml of 0.3% ropivacaine was injected. Intercostal nerve blockade: The range of intercostal blockade was determined based on the location of the breast surgery. The needle was inserted into the intercostal space from the posterior axillary line, and 3ml of 0.3% ropivacaine was injected into each intercostal space.<br>|
| Active Comparator: C Group<br>C Group underwent laryngeal mask insertion after general anesthesia induction. | Combination Product: General anesthesia with laryngeal mask<br>* The C Group underwent general anesthesia induction using TCI propofol 3-3.5μg/ml, TCI remifentanil 1-2ng/ml, sufentanil 0.3μg/kg iv, midazolam 0.05mg/kg iv, and rocuronium 0.6mg/kg iv after loss of consciousness. After muscle relaxation, the laryngeal mask was inserted, and mechanical ventilation was performed with a tidal volume of 6ml/kg. Anesthesia maintenance included propofol 3-4μg/ml and remifentanil 1-2ng/ml.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative QoR-15 at 6 hours | The 15-item quality of recovery(QoR-15) at 6 hours after the surgery. | 6 hours after the surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative NRS pain score at 6 hours | Postoperative numeric rating scales pain score at 6 hours after the surgery. Postoperative pain severity at rest and movement measured using a numerical rating scale(NRS) at 24 h. The numerical rating scale (NRS) is a line with numbers from 0 to 10 are spaced evenly across the page. And the NRS is bounded at the left-most end with no pain and at the right-most end with worst pain imaginable. Pain levels below 4 are considered mild, 4-7 is moderate pain, and anything above 7 is considered severe pain. Patients are instructed to circle the number that represents the amount of pain that they are experiencing at the time of the evaluation. The movement status refers to maximum mobility of the upper arm of the surgical side. Remedial pain relief measures are initiated when the Numeric Rating Scale (NRS) score exceeds 4. | 6 hours after the surgery | 
| the number of patients who experience intraoperative hypotension | During the surgery and anesthesia process, a systolic blood pressure below 80mmHg is defined as intraoperative hypotension. Record the number of patients who experience intraoperative hypotension. | From the beginning of anesthesia to the end of the surgery. | 
| Changes in hemodynamics (mean arterial pressure) after the surgical incision. | Monitor the magnitude of hemodynamic changes compared to baseline after the incision. The main comparison is the magnitude of changes in mean arterial pressure between the two groups. | From the beginning of anesthesia to three minutes after the surgical incision. | 
| Changes in hemodynamics (heart rate) after the surgical incision. | Monitor the magnitude of hemodynamic changes compared to baseline after the incision. The main comparison is the magnitude of changes in heart rate between the two groups. | From the beginning of anesthesia to three minutes after the surgical incision. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dexmedetomidine, breast-conserving surgery, sentinel lymph node biopsy, quality of recovery, Pectoral nerves block II, intercostal nerve block