Our Summary

This research compared two types of nerve block treatments - pectoral nerve block II (PECS II) and erector spinae plane (ESP) block - for pain relief after a specific type of breast cancer surgery, modified radical mastectomy. They also compared these treatments with the standard method of pain relief, systemic analgesia, which involves taking pain medication that affects the whole body.

To do this, they searched through four major online medical databases to find studies that had already compared these treatments. They looked at how much opioid pain medication patients needed in the 24 hours after their surgery and their pain scores during this time.

They found 17 studies involving a total of 1069 patients. They used complex statistical techniques to combine the results of these studies.

They found that patients who received either of the nerve block treatments needed less opioid medication than those who received systemic analgesia. The amount was 10 mg less with PECS II and 5.7 mg less with ESP.

Patients who received the PECS II treatment also reported lower pain scores in the first 24 hours after surgery than those who received systemic analgesia. There was no difference in pain scores for the ESP treatment.

Overall, the researchers concluded that both nerve block treatments were more effective for post-surgery pain relief than systemic analgesia. The PECS II treatment appeared to be the best of the three options.

FAQs

  1. What types of nerve block treatments were compared in this research for post-surgery pain relief?
  2. How did the researchers determine the effectiveness of the nerve block treatments compared to systemic analgesia?
  3. Which nerve block treatment was found to be the most effective for pain relief after a modified radical mastectomy?

Doctor’s Tip

A doctor might tell a patient undergoing a radical mastectomy that nerve block treatments like pectoral nerve block II (PECS II) or erector spinae plane (ESP) block can provide better pain relief than systemic analgesia (pain medication that affects the whole body). These nerve block treatments have been shown to reduce the amount of opioid medication needed after surgery and can also result in lower pain scores in the first 24 hours post-surgery. Discussing these options with your healthcare provider can help you prepare for a smoother recovery process.

Suitable For

Radical mastectomy is a surgical procedure that involves the removal of the breast tissue, chest muscles, and lymph nodes in the armpit. This procedure is typically recommended for patients with advanced or aggressive forms of breast cancer, such as triple-negative breast cancer or inflammatory breast cancer. It may also be recommended for patients who have a high risk of recurrence or have large tumors that involve the chest wall.

Patients who undergo radical mastectomy may experience significant pain and discomfort following surgery, making effective pain management essential for their recovery. The use of nerve block treatments, such as PECS II and ESP blocks, can help reduce the amount of opioid medication needed for pain relief and improve overall patient outcomes. These treatments may be particularly beneficial for patients undergoing modified radical mastectomy, as demonstrated by the findings of the research study discussed above.

Timeline

Before radical mastectomy:

  • Patient is diagnosed with breast cancer
  • Consultation with surgeon and anesthesiologist
  • Pre-operative preparation and tests
  • Surgery is scheduled
  • Patient undergoes radical mastectomy, which involves removing the entire breast, underlying chest muscles, and nearby lymph nodes

After radical mastectomy:

  • Patient wakes up in recovery room
  • Pain management is initiated, typically with systemic analgesia
  • Patient may experience pain, discomfort, and limited mobility in the chest and arm area
  • Patient may be discharged from the hospital within a few days
  • Follow-up appointments with surgeon and oncologist to monitor healing and discuss further treatment options
  • Patient may experience physical and emotional challenges related to body image, self-esteem, and overall well-being
  • Patient may undergo reconstructive surgery or other treatments to help with recovery and adjustment to life after mastectomy.

What to Ask Your Doctor

  1. What is a radical mastectomy and why is it recommended for my specific situation?
  2. What are the potential risks and complications associated with a radical mastectomy?
  3. How will a radical mastectomy affect my daily activities and quality of life?
  4. What are the alternative treatment options available for my condition?
  5. How long will the recovery process be after a radical mastectomy?
  6. What are the potential long-term effects of a radical mastectomy on my health?
  7. What type of pain relief options will be available to me after the surgery?
  8. How do nerve block treatments like PECS II and ESP differ from systemic analgesia in terms of pain relief?
  9. What are the potential side effects or complications associated with nerve block treatments?
  10. Based on my individual situation, which pain relief option would you recommend for me and why?

Reference

Authors: Hong B, Bang S, Oh C, Park E, Park S. Journal: J Anesth. 2021 Oct;35(5):723-733. doi: 10.1007/s00540-021-02923-x. Epub 2021 Mar 30. PMID: 33786681