Parasternal Intercostal Block Complementation Contributes to Postoperative Pain Relief in Modified Radical Mastectomy Employing Pectoral Nerve Block I and Serratus-Intercostal Block: A Randomized Trial

Wen-Qin Song; Wei Wang; Ying-Cong Yang; Qian Sun; Hui Chen; Lei Zhang; Xue-Shan Bu; Li-Ying Zhan; Zhong-Yuan Xia

doi:10.2147/JPR.S237435

Parasternal Intercostal Block Complementation Contributes to Postoperative Pain Relief in Modified Radical Mastectomy Employing Pectoral Nerve Block I and Serratus-Intercostal Block: A Randomized Trial

J Pain Res. 2020 Apr 30:13:865-871. doi: 10.2147/JPR.S237435. eCollection 2020.

Authors

Wen-Qin Song¹, Wei Wang¹, Ying-Cong Yang¹, Qian Sun¹, Hui Chen¹, Lei Zhang¹, Xue-Shan Bu¹, Li-Ying Zhan¹, Zhong-Yuan Xia¹

Affiliation

¹ Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.

Abstract

Purpose: Pectoral nerve block I (PECS I) and serratus-intercostal plane block (SIPB) can anesthetize the majority mammary region, while parasternal intercostal block (PSI) targets the internal area during breast resection surgery. The aim of this study was to determine whether including PSI with PECS I and SIPB is more effective compared to PECS I and SIPB alone.

Patients and methods: Sixty-two adult females undergoing unilateral modified radical mastectomy (MRM) were randomly assigned to receive either PECS I and SIPB (PS group, n=31) or a combination of PECS I, SIPB, and PSI (PSP group, n=31). The outcomes were measured with a numerical rating scale (NRS) score, and in terms of opioid consumption and anesthesia-related complications within 48 h after surgery.

Results: Although there were no differences in the NRS scores between the two groups during the inactive periods, the combination of three nerve blocks significantly reduced the NRS scores during movement. In addition, morphine equivalent consumption was lower in the PSP group compared to the PS group. Postoperative adverse events were similar in both groups in terms of regional anesthesia-related complications.

Conclusion: The combination of PECS I block, SIPB, and PSI block provides superior pain relief and postoperative recovery for patients undergoing MRM.

Keywords: modified radical mastectomy; parasternal intercostal block; pectoral nerve block; postoperative analgesia; serratus-intercostal plane block.