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ISSN: 1642-5758
Anaesthesiology Intensive Therapy
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vol. 54
Original paper

Efficacy of type-I and type-II pectoral nerve blocks (PECS I and II) in patients undergoing mastectomy: a prospective randomised clinical trial

Fabricio Tavares Mendonça
Antonio Vinicius de Assis Feitosa Junior
Huana Christina Rosa Nogueira
Heloisa Helena Roncolato
Catia Sousa Goveia

Teaching and Training Centre in Anaesthesiology, Hospital de Base do Distrito Federal, Brasília, Distrito Federal, Brazil
University of Brasília, Anaesthesiology Centre, Brasília, Distrito Federal, Brazil
Anaesthesiol Intensive Ther 2022; 54, 4: 302–309
Online publish date: 2022/11/17
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The benefits of type I/II pectoral nerve blocks (PECS I/II), which can be dose dependent, have been examined in different studies. Nonetheless, few randomised trials have been performed in South America. The present randomised trial examined the efficacy of PECS I/II with a higher dose of the local anaesthetic to manage perioperative pain after mastectomy in Brazil.

Material and methods
This was a randomised, parallel, single-centre, and single-blind trial. Eighty participants undergoing elective mastectomy were randomised (1 : 1) to receive PECS I/II plus ultrasound-guided ropivacaine (0.5%) or standard general anaesthesia. The primary outcome was pain intensity at rest 24 hours after surgery, assessed with a numerical rating scale. Haemodynamic outcomes, consumption of opioids, anaesthe­tics and antiemetics, and post-anaesthetic recovery times were also recorded.

Sixty participants (75%) completed the study. The mean age was 54 years, with 57% of participants undergoing mastectomy and 43% undergoing quadrantectomy. Median pain intensity (interquartile range) at rest (24 h postoperatively) was lower in the PECS I/II group compared to the control group: 0 (0–1.75) vs. 1 (1–2), P = 0.021. A smaller number of patients in the PECS I/II group required intraoperative fentanyl (23.3% vs. 83.3%; P < 0.001) and postoperative tramadol (20.0 vs. 76.7%; P < 0.001). Mean doses of fentanyl and tramadol were about 4-5 times lower in the PECS I/II group (P < 0.001). PECS I/II significantly reduced sevoflurane consumption during surgery (P = 0.01). No difference was observed regarding adverse effects.

PECS I/II blockade with high-dose local anaesthetic is efficacious and safe, resulting in lower levels of perioperative pain after mastectomy compared to standard general anaesthesia.


local anaesthetics, peripheral nerve block, postoperative pain, mastectomy

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