Analgesic efficacy and safety of ultrasound-guided pectoral nerve (PECS II) block in patients undergoing breast cancer surgery

In our study, we aimed to find out the effect of preoperative PECS II block on perioperative opioid consumption, postoperative pain scores, chronic pain in the 3rd postoperative month, and patient and operator satisfaction in patients undergoing unilateral breast cancer surgery. After obtaining Ethics Committee approval, a total of 68 ASA I-II-III patients between the ages of 18-75, who were planned to undergo unilateral breast cancer surgery, were divided into two groups by the sealed envelope method, after their written consent was obtained. Patients in the PECS II block group underwent PECS II block preoperatively under USG guidance. No block was applied to the patients in the control group. Standard anesthesia method was applied to the patients with remifentanil infusion. Drug doses were adjusted by measuring hemodynamic values every 15 minutes. For postoperative analgesia, 1 gram of paracetamol was given IV every 8 hours to both groups. Pain assessment was made using the NRS scale at 0, 1, 2, 6, 12, and 24 hours postoperatively. For values of 4 and above, 100 mg tramadol was administered as an additional analgesic. Patient and operator satisfaction was questioned with a 5-point Likert scale. The patients were called by phone at the 3rd postoperative month and chronic pain evaluation was performed using the KMSA table. Statistically significantly lower levels of intraoperative remifentanil (p<0.001) and postoperative tramadol use (p<0.001) were detected in the PECS II block group compared to the control group. Postoperative NRS scores were found to be significantly lower in the PECS II block group at all hours (p<0.001). Postoperative additional analgesic need was detected statistically significantly later in the PECS II block group compared to the control group (p = 0.002). Although chronic pain was found to be lower in the PECS II block group, it did not reach statistical significance (p = 0.056). Patient and operator satisfaction was found to be statistically significantly higher in the PECS II block group (p<0.001). No complications were encountered in the block group. In conclusion; PECS II block can be used in perioperative analgesia in breast cancer surgery and is a safe and effective block. More comprehensive studies are needed to evaluate its effect on chronic pain. Key words: PECS II block, Pectoral nerve block, mastectomy, breast-conserving surgery, postoperative pain, tramadol