Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: A randomized controlled trial

Background: Breast surgery is commonly performed in geriatric patients. In this age group, patients commonly suffer from comorbidities, making regional anesthesia the preferred option during surgery. Both segmental thoracic spinal anesthesia (TSA), thoracic paravertebral (TPB) and pectoral nerve (Pecs) blocks were tried successfully. This encouraged us to compare between segmental thoracic spinal anesthesia (TSA) and pectoral nerve (Pecs) block for surgeries in the thoracic region, namely breast surgery. Methods: Forty (ASA) I-II patients aged between 40-65 years with cancer breast surgeries were enrolled in this study. In regard to anesthetic choice, patients were randomly divided into two groups, with 20 patients in each: Group A, with pectoral nerve block and group B, with thoracic spinal block. Standard monitoring in the form of mean blood pressure (MBP) and heart rate (HR) was recorded. Onset time for sensory block, time to reach peak sensory level, regression times of motor blocks and sensory blocks. Intraoperative VAS and post-operative VAS were recorded. Any postoperative complications such as bradycardia, hypotension, nausea and vomiting were assessed. Results: The time onset of both sensory and motor blocks was compared; there was statistically significant difference between both groups (P < 0.05). T1 was the highest level of sensory block attained at 17.7 +/- 1.7 and 5.5 +/- 1.6 min after injection in group A, and group B respectively and the total time for block was significantly prolonged in group A (940.3 +/- 17.2 min) compared to group B (315.5 +/- 44.3 min) as P <= 0.0001. Regression times of motor blocks and sensory blocks, were significantly prolonged in group A (994 +/- 55 min, 940 +/- 34 min) compared to group B (382 +/- 45 min, 351 +/- 35 min) as P < 0.0001. Also, there was significant prolongation of duration of postoperative analgesia with significant reduction of total fentanyl requirement during the first 24 h postoperative in group A compared to group B. Regarding the hemodynamic variables (MBP, HR), there were significant decrease in HR and mean blood pressure (MBP) between the both groups throughout the intraoperative and early postoperative periods. Conclusion: In conclusion, both Pecs and TSB provide effective intraoperative anesthesia and prolonged postoperative pain relief after breast surgery, but the Pecs block is technically simple and easy to learn with few contraindications, provides hemodynamic stability, and has a low complication rate and it is therefore a safe and effective technique in performing intraoperative anesthesia and controlling postoperative pain after unilateral conservative breast surgery. (C) 2015 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists.