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The Use of Pectoralis Blocks in Breast Surgery: A Practice Advisory and Narrative Review from the Society for Ambulatory Anesthesia (SAMBA).

Authors :
Ardon AE
George JE 3rd
Gupta K
O'Rourke MJ
Seering MS
Tokita HK
Wilson SH
Moo TA
Lizarraga I
McLaughlin S
Greengrass RA
Source :
Annals of surgical oncology [Ann Surg Oncol] 2022 Aug; Vol. 29 (8), pp. 4777-4786. Date of Electronic Publication: 2022 Apr 15.
Publication Year :
2022

Abstract

Although pectoralis (PECS) blocks are commonly used for breast surgery, recommendations regarding the efficacy of these blocks have thus far not been developed by any professional anesthesia society. Given the potential impact of PECS blocks on analgesia after outpatient breast surgery, The Society for Ambulatory Anesthesia (SAMBA) convened a task force to develop a practice advisory on the use of this analgesic technique. In this practice advisory, we compare the efficacy of PECS blocks with systemic analgesia, local infiltration anesthesia, and paravertebral blockade. Our objectives were to advise on two clinical questions. (1) Does PECS-1 and/or -2 blockade provide more effective analgesia for breast-conserving surgery than either systemic analgesics or surgeon-provided local infiltration anesthesia? (2) Does PECS-1 and/or -2 blockade provide equivalent analgesia for mastectomy compared with a paravertebral block (PVB)? Among patients undergoing breast-conserving surgery, PECS blocks moderately reduce postoperative opioid use, prolong time to analgesic rescue, and decrease postoperative pain scores when compared with systemic analgesics. SAMBA recommends the use of a PECS-1 or -2 blockade in the absence of systemic analgesia (Strength of Recommendation A). No evidence currently exists that strongly favors the use of PECS blocks over surgeon-performed local infiltration in this surgical population. SAMBA cannot recommend PECS blocks over surgical infiltration (Strength of Recommendation C). For patients undergoing a mastectomy, a PECS block may provide an opioid-sparing effect similar to that achieved with PVB; SAMBA recommends the use of a PECS block if a patient is unable to receive a PVB (Strength of Recommendation A).<br /> (© 2022. Society of Surgical Oncology.)

Details

Language :
English
ISSN :
1534-4681
Volume :
29
Issue :
8
Database :
MEDLINE
Journal :
Annals of surgical oncology
Publication Type :
Academic Journal
Accession number :
35428960
Full Text :
https://doi.org/10.1245/s10434-022-11724-9