Our Summary

This study looked at the effectiveness of two different types of pain relief techniques after breast removal surgery (radical mastectomy): the PECS block and the paravertebral block. Researchers analyzed data from eight different studies that included a total of 388 patients.

The main measure they looked at was the patient’s pain score two hours after surgery. They found that patients who received a PECS block had slightly lower pain scores than those who received a paravertebral block. However, this difference was only significant when the breast removal surgery did not include removal of lymph nodes in the armpit (axillary dissection). When lymph nodes were removed, there was no significant difference in pain scores between the two types of pain relief.

The researchers also looked at other measures of pain relief, including pain scores 24 hours after surgery, the amount of morphine-like drugs patients needed, and the rate of post-surgery nausea and vomiting. They found no significant difference between the two types of pain relief for these measures.

The researchers concluded that there is only low quality evidence to show that a PECS block provides a small amount of additional pain relief two hours after breast removal surgery compared to a paravertebral block. This benefit does not appear to last beyond the two-hour mark.

FAQs

  1. What is the main difference in pain relief between the PECS block and the paravertebral block after radical mastectomy?
  2. Does the removal of lymph nodes during a radical mastectomy affect the effectiveness of PECS block and paravertebral block?
  3. What other measures of pain relief were examined in this study apart from the patient’s pain score two hours after surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about radical mastectomy is to discuss pain management options with their healthcare team before the surgery. This may include exploring the possibility of receiving a PECS block or paravertebral block for pain relief after the procedure. It’s important for patients to have open communication with their healthcare providers to ensure they receive the most effective pain management plan tailored to their individual needs.

Suitable For

Patients who are typically recommended radical mastectomy are those with a large tumor in the breast that cannot be removed with a lumpectomy, those with multiple tumors in the breast, those with tumors that are close to the chest wall, or those with a genetic mutation that increases the risk of breast cancer. Additionally, patients with inflammatory breast cancer or locally advanced breast cancer may also be recommended for radical mastectomy.

Timeline

Overall, the timeline of what a patient experiences before and after a radical mastectomy may include:

Before surgery:

  • Consultation with a surgeon to discuss the procedure and potential risks and benefits
  • Pre-operative tests and preparations
  • Pre-surgery counseling and education on what to expect during and after the surgery
  • Consent forms and paperwork to be signed
  • Anesthesia consultation

During surgery:

  • Radical mastectomy procedure, which involves removal of the breast tissue, lymph nodes, and sometimes chest wall muscle
  • Administration of pain relief medication and anesthesia

After surgery:

  • Recovery in the post-anesthesia care unit (PACU)
  • Assessment of pain levels and management with pain relief medication
  • Monitoring for any complications, such as bleeding or infection
  • Physical therapy and rehabilitation to regain strength and mobility in the affected arm and shoulder
  • Emotional support and counseling to cope with the physical and emotional changes post-surgery

Long-term:

  • Follow-up appointments with the surgeon and oncologist to monitor recovery and discuss any further treatment options
  • Breast reconstruction surgery, if desired
  • Support groups and counseling to cope with body image changes and emotional challenges
  • Regular screenings and check-ups to monitor for recurrence or new cancer developments.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a radical mastectomy?
  2. How long is the recovery period expected to be after a radical mastectomy?
  3. What are the potential long-term effects of a radical mastectomy on my overall health and well-being?
  4. Are there any alternative treatment options to consider instead of a radical mastectomy?
  5. How will a radical mastectomy impact my daily activities and quality of life?
  6. What are the chances of the cancer returning after a radical mastectomy?
  7. Will I need any additional treatments, such as chemotherapy or radiation therapy, after a radical mastectomy?
  8. What support resources are available for patients undergoing a radical mastectomy?
  9. How often will I need to follow up with my doctor after a radical mastectomy?
  10. Are there any clinical trials or research studies that I may be eligible to participate in related to radical mastectomy and pain management techniques?

Reference

Authors: Grape S, El-Boghdadly K, Albrecht E. Journal: J Clin Anesth. 2020 Aug;63:109745. doi: 10.1016/j.jclinane.2020.109745. Epub 2020 Feb 26. PMID: 32113076