Anesth Pain Med.  2019 Apr;14(2):222-229. 10.17085/apm.2019.14.2.222.

Thoracic interfascial plane block for multimodal analgesia after breast lumpectomy

• Kim Y
• Oh C
• Youn S
• Yun S
• Park H
• Lee W
• Kim YH
• Ko Y
• Hong B

• KMID: 2447974
• DOI: http://doi.org/10.17085/apm.2019.14.2.222

Abstract

BACKGROUND
Thoracic interfascial plane block is useful as a component of multimodal analgesia in patients undergoing mastectomy. However, multimodal analgesia tends not to be provided during lumpectomy as it is one of the less aggressive procedures among breast cancer surgeries. Therefore, we investigated the effects of thoracic interfascial plane block as more effective analgesia after breast lumpectomy.
METHODS
Forty six patients (20-80 years old, female) with breast cancer scheduled to undergo lumpectomy were randomly assigned to two groups. Postoperative pain control in the control group consisted only of intravenous patient-controlled analgesia (PCA). In the block group, intravenous PCA was used after serratus intercostal fascial plane block and pecto-intercostal fascial plane block. The primary outcome was the 24 h cumulative postoperative fentanyl consumption. Pain severity, additional rescue analgesic requirement, side effects, and patient satisfaction were also evaluated.
RESULTS
Postoperative fentanyl consumption in the block group was significantly reduced compared with the control group (median, 88.8 [interquartile range, 48.0, 167.6] vs. 155.2 [88.8, 249.2], P = 0.022). The pain score was significantly lower in the block group only in the post-anesthesia care unit (2.9 ± 1.8 vs. 4.3 ± 2.3, P = 0.022). There were no differences in the incidence of postoperative nausea and vomiting and the requirement for additional analgesics between the groups. The satisfaction score was significantly higher in the block group.
CONCLUSIONS
Thoracic interfascial plane block after lumpectomy reduces opioid usage and increases patient satisfaction with postoperative pain control. Thoracic interfascial plane block is useful for multimodal analgesia after lumpectomy.

Keyword

Analgesics, opioid; Mastectomy, segmental; Nerve block; Postoperative pain

MeSH Terms

Analgesia*
Analgesia, Patient-Controlled
Analgesics
Analgesics, Opioid
Breast Neoplasms
Breast*
Fentanyl
Humans
Incidence
Mastectomy
Mastectomy, Segmental*
Nerve Block
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Patient Satisfaction
Postoperative Nausea and Vomiting
Analgesics
Analgesics, Opioid
Fentanyl

Figure

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  Fig. 1 Consolidated Standards of Reporting Trials (CONSORT) flow diagram of a randomized trial of two groups. PCA: patient-controlled analgesia, PONV: postoperative nausea and vomiting, IV: intravenous, ITT: intention to treat.

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  Fig. 2 Postoperative fentanyl consumption for first 24 h. *P < 0.05 between two groups.

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  Fig. 3 Postoperative numeric rating scale pain scores. PACU: post-anesthesia care unit. *P < 0.05 between two groups.

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