The analgesic efficacy of pectoral nerve block for breast augmentation: a meta-analysis of randomized controlled studies
DOI:
https://doi.org/10.2340/jphs.v58.9395Keywords:
Breast augmentation, pectoral nerve block, pain control, meta-analysisAbstract
Background: Many patients suffered from serious pain after breast augmentation, but the analgesic efficacy of pectoral nerve block for these patients was not well established. Thus, this meta-analysis was intended to study the analgesic efficacy of pectoral nerve block for breast augmentation.
Methods: Several databases including PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases were searched, and we included randomized controlled trials (RCTs) regarding the analgesic efficacy of pectoral nerve block for breast augmentation.
Results: Six RCTs were ultimately included in this meta-analysis. Compared with control intervention for breast augmentation, pectoral nerve block could significantly reduce pain scores at 1 h (mean difference [MD] = −2.28; 95% confidence interval [CI] = −3.71 to −0.85; P = 0.002), 2 h (MD = −3.08; 95% CI = −3.95 to −2.20; P < 0.00001), 4 h (MD = −2.95; 95% CI = −3.32 to −2.58; P < 0.00001), 6–8 h (MD = −2.68; 95% CI = −3.24 to −2.11; P < 0.00001), 24 h (MD = −2.04; 95% CI = −2.41 to −1.67; P < 0.00001), the number of analgesic requirement (odd ratio [OR] = 0.20; 95% CI = 0.09 to 0.45; P = 0.0001), and the incidence of nausea (OR = 0.21; 95% CI = 0.08 to 0.54; P = 0.001) and vomiting (OR = 0.15; 95% CI = 0.05 to 0.39; P = 0.0001).
Conclusions: Pectoral nerve block may be effective for pain relief after breast augmentation.
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References
Graf RM, Junior IM, de Paula DR, et al. Subfascial versus subglandular breast augmentation: a randomized prospective evaluation considering a 5-year follow-up. Plast Reconstr Surg. 2021;148(4): 760–770. https://doi.org/10.1097/PRS.0000000000008384 DOI: https://doi.org/10.1097/PRS.0000000000008384
Öztürk G, Beyazyüz E, Albayrak Y, et al. Favorable personality traits in women who have undergone cosmetic breast augmentation surgery. Eur J Breast Health. 2021;17(4):308–314. https://doi.org/10.4274/ejbh.galenos.2020.6276 DOI: https://doi.org/10.4274/ejbh.galenos.2020.6276
Phillips NA, Millan LS, Miroshnik M, et al. A novel classification of the inframammary fold for use in primary breast augmentation. Plastic Reconstr Surg. 2021;148(6):903e–914e. https://doi.org/10.1097/PRS.0000000000008563 DOI: https://doi.org/10.1097/PRS.0000000000008563
Schrager S, Lyon SM, Poore SO. Breast implants: common questions and answers. Am Fam Physician. 2021;104(5):500–508.
Sforza M, Spear S. Hybrid implant and grafted fat breast augmentation: designing the pathway to a future with breasts free of silicone breast implants. Aesthet Surg J. 2021;41(11):Np1473–Np1485. https://doi.org/10.1093/asj/sjab195 DOI: https://doi.org/10.1093/asj/sjab195
von Sperling ML, Høimyr H, Finnerup K, et al. Persistent pain and sensory changes following cosmetic breast augmentation. Eur J Pain. 2011;15(3):328–332. https://doi.org/10.1016/j.ejpain.2010.07.004 DOI: https://doi.org/10.1016/j.ejpain.2010.07.004
Buckley CE, Concannon ES, Beecher SM, et al. A double-blind, placebo-controlled randomised trial of intraparenchymal administration of local anaesthetic in elective breast augmentation. J Plastic Reconstr Aesthet Surg. 2022;75(3):1204–1208. https://doi.org/10.1016/j.bjps.2021.09.003 DOI: https://doi.org/10.1016/j.bjps.2021.09.003
Durán-Vega HC, Ramírez-Montañana A, Gonzalez Galindo O, et al. Ropivacaine in breast augmentation surgery. Plast Reconstr Surg Global Open. 2018;6(5):e1745. https://doi.org/10.1097/GOX.0000000000001745 DOI: https://doi.org/10.1097/GOX.0000000000001745
Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 Suppl):S105–S120. https://doi.org/10.36076/ppj.2008/11/S105 DOI: https://doi.org/10.36076/ppj.2008/11/S105
Zhang Y, He B, Zhao J, et al. Addition of celebrex and pregabalin to ropivacaine for posterior spinal surgery: a randomized, double-blinded, placebo-controlled trial. Drug Des Devel Ther. 2021;15:735–742. https://doi.org/10.2147/DDDT.S292847 DOI: https://doi.org/10.2147/DDDT.S292847
Blanco R. The ‘pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011;66(9):847–848. https://doi.org/10.1111/j.1365-2044.2011.06838.x DOI: https://doi.org/10.1111/j.1365-2044.2011.06838.x
Leiman D, Barlow M, Carpin K, et al. Medial and lateral pectoral nerve block with liposomal bupivacaine for the management of postsurgical pain after submuscular breast augmentation. Plast Reconstr Surg Global Open. 2014;2(12):e282. https://doi.org/10.1097/GOX.0000000000000253 DOI: https://doi.org/10.1097/GOX.0000000000000253
Kulhari S, Bharti N, Bala I, et al. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Br J Anaesth. 2016;117(3):382–386. https://doi.org/10.1093/bja/aew223 DOI: https://doi.org/10.1093/bja/aew223
Bashandy GM, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med. 2015;40(1):68–74. https://doi.org/10.1097/AAP.0000000000000163 DOI: https://doi.org/10.1097/AAP.0000000000000163
Morioka H, Kamiya Y, et al. Pectoral nerve block combined with general anesthesia for breast cancer surgery: a retrospective comparison. JA Clin Rep. 2015;1(1):15. https://doi.org/10.1186/s40981-015-0018-1 DOI: https://doi.org/10.1186/s40981-015-0018-1
Karaca O, Pınar HU, Arpacı E, et al. The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: a prospective, randomised study. Anaesth Crit Care Pain Med. 2019;38(1): 47–52. https://doi.org/10.1016/j.accpm.2018.03.009 DOI: https://doi.org/10.1016/j.accpm.2018.03.009
Aarab Y, Ramin S, Odonnat T, et al. Pectoral nerve blocks for breast augmentation surgery: a randomized, double-blind, dual-centered controlled trial. Anesthesiology. 2021;135(3):442–453. https://doi.org/10.1097/ALN.0000000000003855 DOI: https://doi.org/10.1097/ALN.0000000000003855
Ciftci B, Ekinci M, Celik EC, et al. Ultrasound-guided pectoral nerve block for pain control after breast augmentation: a randomized clinical study. Braz J Anesthesiol. 2021;71(1):44–49. https://doi.org/10.1097/ALN.0000000000003855 DOI: https://doi.org/10.1016/j.bjane.2020.12.004
Desroches J, Roy M, Belliveau M, et al. PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study. Braz J Anesthesiol. 2020;70(4):333–342. https://doi.org/10.1016/j.bjan.2020.04.013 DOI: https://doi.org/10.1016/j.bjane.2020.07.004
Ekinci M, Ciftci B, Celik EC, et al. The efficacy of different volumes on ultrasound-guided type-I pectoral nerve block for postoperative analgesia after subpectoral breast augmentation: a prospective, randomized, controlled study. Aesthet Plast Surg. 2019;43(2):297–304. https://doi.org/10.1007/s00266-019-01322-8 DOI: https://doi.org/10.1007/s00266-019-01322-8
Schuitemaker RJ, Sala-Blanch X, Sánchez Cohen AP, et al. Analgesic efficacy of modified pectoral block plus serratus plane block in breast augmentation surgery: a randomised, controlled, triple-blind clinical trial. Rev Esp Anestesiol Reanim. 2019; 66(2): 62–71. https://doi.org/10.1016/j.redare.2018.08.010 DOI: https://doi.org/10.1016/j.redare.2018.08.010
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. https://doi.org/10.1136/bmj.b2535 DOI: https://doi.org/10.1136/bmj.b2535
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011. Available from: www.cochrane-handbook.org
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12. https://doi.org/10.1016/0197-2456(95)00134-4 DOI: https://doi.org/10.1016/0197-2456(95)00134-4
He B, Zhao J-Q, Zhang M-Z, Quan Z-X. Zoledronic acid and fracture risk: a meta-analysis of 12 randomized controlled trials. Am J Rhinol Allergy. 2021;25:1564–1573.
Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med. 2001;135(11):982–989. https://doi.org/10.7326/0003-4819-135-11-200112040-00010 DOI: https://doi.org/10.7326/0003-4819-135-11-200112040-00010
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–1558. https://doi.org/10.1002/sim.1186 DOI: https://doi.org/10.1002/sim.1186
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926. https://doi.org/10.1136/bmj.39489.470347.AD DOI: https://doi.org/10.1136/bmj.39489.470347.AD
Broyles JM, Tuffaha SH, Williams EH, et al. Pain after breast surgery: etiology, diagnosis, and definitive management. Microsurgery. 2016;36(7):535–538. https://doi.org/10.1002/micr.30055 DOI: https://doi.org/10.1002/micr.30055
Aubrun F, Ecoffey C, Benhamou D, et al. Perioperative pain and post-operative nausea and vomiting (PONV) management after day-case surgery: the SFAR-OPERA national study. Anaesth Crit Care pain Med. 2019;38(3):223–229. https://doi.org/10.1016/j.accpm.2018.08.004 DOI: https://doi.org/10.1016/j.accpm.2018.08.004
Urits I, Lavin C, Patel M, et al. Chronic pain following cosmetic breast surgery: a comprehensive review. Pain Ther. 2020;9(1):71–82. https://doi.org/10.1007/s40122-020-00150-y DOI: https://doi.org/10.1007/s40122-020-00150-y
Wang L, Cohen JC, Devasenapathy N, et al. Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies. Br J Anaesth. 2020;125(3):346–357. https://doi.org/10.1016/j.bja.2020.04.088 DOI: https://doi.org/10.1016/j.bja.2020.04.088
Stanley SS, Hoppe IC, Ciminello FS. Pain control following breast augmentation: a qualitative systematic review. Aesthet Surg J. 2012;32(8):964–972. https://doi.org/10.1177/1090820X12457014 DOI: https://doi.org/10.1177/1090820X12457014
Helander EM, Webb MP, Kendrick J, et al. PECS, serratus plane, erector spinae, and paravertebral blocks: a comprehensive review. Best Pract Res Clin Anaesthesiol. 2019;33(4):573–581. https://doi.org/10.1016/j.bpa.2019.07.003 DOI: https://doi.org/10.1016/j.bpa.2019.07.003
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