continuous pecs for MRM - Trial PACTR201707002385379

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Summary

Breast cancer is the most common cancer among women that require breast surgery. [1,2] Acute postoperative pain is a risk factor for chronic postoperative pain after breast surgery [3] Effective postoperative painmanagement is necessary.Systemic opioids can be administered using patient-controlled devices but the analgesic effect can be limited and undesirable side effects may occur. [4]Thoracic paravertebral block (TPVB) consists in the administration of a local anestheticsolution close to the spinal cord nerve roots after their exit from the intervertebral foramen [5, 6]. Injection into the thoracic paravertebral space through a catheter demonstratesvertical diffusion lateral to the vertebral column between the parietal pleura and the endothoracic fascia [7, 8]. Continuous paravertebral nerve block has the advantages of equivalent analgesia as an epidural technique but with less risk of block failure, dural puncture, cord trauma, and clinically significant side effects, including hypotension. Additionally, urinary catheterization is not necessary. [9]Pectoral nerve (Pecs) blocks are ultrasound guided interfascial plane blocks that target tissue planes between the pectoralis major and minor (Pecs I), and the pectoralis minor and serratus anterior muscles (Pecs II) [10,11]. Targeting these planes with local anesthetic blocks the medial and lateral pectoral nerves, anterior divisions of the thoracic intercostal nerves from T2 to T6, long thoracic nerve, and thoracodorsal nerves providing analgesia to the anterior and lateral thoracic walls with an extension into axilla. Pecs blocks have shown excellent efficacy for analgesia after breast surgery.[12]The aim of the current study is to compare the effects of three techniques ; continuous thoracic paravertebral block, continuous Pectoral nerve block and PCA IV morphine on postoperative pain and rescue analg

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