The role of pectoral nerve blocks in a day-case mastectomy service: A prospective cohort study. (December 2019) - Bell, Ashleigh
Abstract: Background: It is now recognised that the majority of breast surgery can be safely undertaken as day case procedures. We aimed to evaluate the effect of pectoral nerve (Pecs2) blocks on recovery parameters and day case rates in patients undergoing mastectomy for breast cancer. Methods: A prospective cohort study was performed in a single NHS Foundation trust between 1st April 2014 and 31st December 2016. Visual analogue scale (VAS) pain scores (0–10) at 4 and 8 h, episodes of post-operative nausea ± vomiting (PONV), opioid use and day case outcome were compared between Pecs2 and no Pecs2 groups. Results: 22 patients underwent general anaesthesia (GA) + Pecs2 block and 30 GA ± local anaesthetic infiltration. Mean pain scores were significantly lower in the Pecs2 (2.5) vs no Pecs2 (4.6) group at 4 h (p = 0.0132) and 8 h, Pecs2 (1.9) vs no Pecs2 (3.6) (p = 0.0038). Episodes of PONV requiring additional anti-emetic were lower and statistically significant in the Pecs2 group (2/22, 9%) than the no Pecs2 group (14/30, 46%), (p = 0.005). Additional opioid use was significantly lower in the Pecs2 group (4/22, 18%) than in the no Pecs2 group (14/30, 46%) (p = 0.0423). 18 patients in the Pecs2 group were discharged the same day in contrast to just 3 patients in the no Pecs2 group. This was highly statistically significant (p = 0.0001). Conclusions: Pecs2 blocks can significantly reduce post-operative pain, nausea and vomiting in patients undergoing mastectomy. Their use can enable units to achieve high day-case mastectomy rates. Highlights: Pecs2 blocks provide good post-operative pain control in mastectomy. Pecs2 blocks reduce levels of nausea compared with GA ± LA. Pecs2 block can help facilitate a high day case rate for mastectomy.