Meme Cerrahisi Geçiren Hastalarda Uygulanan PECS II (pektoral sinir) Bloğunun İntraoperatif ve Postoperatif Etkileri

Mustafa Naci Balıca; Duygu Karaköse Çalışkan; Selcan Yerebakan Akesen; Y. Gürkan Türker

doi:10.32708/uutfd.1580070

Araştırma Makalesi

Effects of PECS II (Pectoral Nerve) Block on Intraoperative Inhaled Anesthetic and Postoperative Analgesic Consumption in Patients Undergoing Breast Surgery

Yıl 2025, Cilt: 51 Sayı: 1, 51 - 58, 27.05.2025

Mustafa Naci Balıca , Duygu Karaköse Çalışkan , Selcan Yerebakan Akesen , Y. Gürkan Türker

https://doi.org/10.32708/uutfd.1580070

Öz

We aimed to evaluate the preoperative and postoperative application of PECS II (Pectoral Nerve) block in breast surgery, intraoperative anesthetic consumption, postoperative analgesic requirement and frequency of complications. A retrospective review of the anesthesia records of 75 patients who underwent breast surgery and analysis of the data was performed. The patients whose data were obtained were categorized into three groups. Group I (n25: control group with general anesthesia), Group II (n25: preoperative PECS II block and general anesthesia) and Group III (n25: postoperative PECS II block and general anesthesia). After analysis of the data, it was found that intraoperative desflurane MAC (minimum alveolar concentration) values were significantly lower in patients who underwent preoperative PECS II block compared to the other groups. Significant decreases in postoperative analgesic consumption and pain scores (early period, postoperative 0, 2, 4 and 8 hours) were observed in the study groups who underwent intraoperative and postoperative PECS II block compared to the control group. The first postoperative analgesic administration time was significantly later in the preoperative PECS II block group than in the general anesthesia only and postoperative PECS II block groups. The time to first postoperative analgesic administration was similar in the general anesthesia only and postoperative PECS II block groups. Adding PECS II block to general anesthesia preoperatively or postoperatively in patients undergoing breast surgery provides postoperative analgesia with less pain. The most important advantage of preoperative application of PECS II block is to reduce intraoperative anesthetic consumption.

Anahtar Kelimeler

pectoral nerve block, postoperative analgesia, breast surgery, regional block

Kaynakça

1. Poleshuck EL, Katz J, Andrus CH, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006;7:626–34.
2. Gärtner R, Jensen MB, Nielsen J, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302:85-92.
3. Blanco R. Bloqueo pectoral (Pecs Block). Manual de anestesia regionalye conoanatomía avanzada. Capítulo 4. Madrid: Editorial Ene; 2011;92-5.
4. Blanco R. The ‘pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011; 66:847-8.
5. Blanco R, Fajardo M, Maldonado TP. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59:470-75
6. Talbot H, Hutchinson SP, Edbrooke DL, Wrench I, Kohlhardt SR. Evaluation of a local anesthesia regimen after mastectomy. Anaesthesia 2004;59:664–67
7. Bashandy GMN, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Regional Anesthesia and Pain Medicine 2015; 40: 68–74.
8. Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anesthesia improves outcome after breast surgery. Ann Surg 1995;222:663-69.
9. Duff S, Connolly C, Buggy DJ. Adrenergic, inflammatory, and immune function in the setting of oncological surgery: their effects on cancer progression and the role of the anesthetic technique in their modulation. Int Anesthesiol Clin. 2016;54:48–57.
10. Iwasaki M, Zhao H, Jaffer T, et al. Volatile anaesthetics enhance the metastasis related cellular signalling including CXCR2 of ovarian cancer cells. Oncotarget. 2016;7:26042–56.
11. Connolly C, Buggy DJ. Opioids and tumour metastasis: does the choice of the anesthetic-analgesic technique influence outcome after cancer surgery? Curr Opin Anaesthesiol. 2016;29:468–74
12. Tripathy S , Rath S , Agrawal S, et al. Opioid-free anesthesia for breast cancer surgery: An observational study. J Anaesthesiol Clin Pharmacol. 2018;34:35-40.
13. Hassn AMA, Zanfaly HE, Biomy TA. Pre-emptive analgesia of ultrasound-guided pectoral nerve block II with dexmedetomidine–bupivacaine for controlling chronic pain after modified radical mastectomy. Research and Opinion in Anesthesia and Intensive Care 2016;3:6-13.
14. Kumar S, Goel D, Sharma SK, et al. A randomised controlled study of the post-operative analgesic efficacy of ultrasound-guided pectoral nerve block in the first 24 h after modified radical mastectomy. Indian Journal of Anaesthesia 2018;62:436-42.
15. Neethu M, Pandey RK, Sharma A, et al. Pectoral nerve blocks to improve analgesia after breast cancer surgery: A prospective, randomized and controlled trial. Journal of Clinical Anesthesia 2018;45:12–17.
16. Leite ALDS, Rocha FTR, Oliveira MJC, et al. Impact of Pectoralis Nerve Block (PECS) on postoperative pain in patients submitted to mastectomy with lymphadenectomy. Rev Col Bras Cir. 2022 Dec 12;49:e20223366.
17. Sun Q, Liu S , Wu H, et al. Clinical analgesic efficacy of pectoral nerve block in patients undergoing breast cancer surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99:e19614.
18. Versyck B, Van Geffen GJ, Van Houwe P. Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II. Journal of Clinical Anesthesia 2017;40:46–50.
19. Kim DH, Kim S, Kim CS, et al. Efficacy of pectoral nerve block type II for breast-conserving surgery and sentinel lymph node biopsy: a prospective randomized controlled Study. Pain Research and Management 2018;20:1–8.
20. Wang K, Zhang X, Zhang T, et al. The Efficacy of Ultrasound-guided Type II Pectoral Nerve Blocks in Perioperative Pain Management for Immediate Reconstruction After Modified Radical Mastectomy. Clinical Journal of Pain 2018;34:231–36.
21. Wahba SS, Kamal SM. Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery. Egyptian Journal of Anaesthesia. 2014;30:129–35.
22. Hong B, Bang S, Oh C, Park E, Park S. Comparison of PECS II and erector spinae plane block for postoperative analgesia following modified radical mastectomy: Bayesian network meta-analysis using a control group. J Anesth. 2021;35:723–33.
23. Versyck B, Van Geffen GJ, Chin KJ. Analgesic efficacy of the Pecs II block: a systematic review and meta-analysis. Anaesthesia. 2019;74:663–73.
24. Senapathi TGA, Widnyana IMG, Aribawa IGNM, Jaya AAPS, Junaedi IMD. Combined ultrasound-guided Pecs II block and general anesthesia are effective for reducing pain from modified radical mastectomy. J Pain Res. 2019;12:1353–58.
25. De Cassai A, Bonanno C, Sandei L, et al. PECS II block is associated with lower incidence of chronic pain after breast surgery. Korean J Pain. 2019;32:286–91.
26. Zhao J, Han F, Yang Y, Li H, Li Z. Pectoral nerve block in anesthesia for modified radical mastectomy: a meta-analysis based on randomized controlled trials. Medicine (Baltimore) 2019;98:e15423.
27. Fancellu A, Perra T, Ninniri C, et al. The emerging role of pectoral nerve block (PECS block) in breast surgery: a case-matched analysis. Breast J. 2020;26:1784–87
28. Kurien RK, Salins SR, Jacob PM, Thomas K. Utility of Pecs block for perioperative opioid-sparing analgesia in cancer-related breast surgery: a randomized controlled trial. Indian J Surg Oncol. 2021;12:713–21.
29. Bakeer A, Abdallah NM. Erector spinae plane block versus PECS block type II for breast surgery: a randomized controlled trial. Anesth Pain Med. 2022;12:e122917.
30. Jin Z, Li R, Gan TJ, He Y, Lin J. Pectoral Nerve (PECs) block for postoperative analgesia-a systematic review and meta-analysis with trial sequential analysis. Int J Physiol Pathophysiol Pharmacol. 2020;12:40–50.
31. Kubodera K, Fujii T, Akane A, et al. Editors' Choice Efficacy of pectoral nerve block type-2 (Pecs II block) versus serratus plane block for postoperative analgesia in breast cancer surgery: a retrospective study. Nagoya J Med Sci. 2020;82:93–99.
32. Uribe AA, Weaver TE, Villalobos ME, et al. Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: a retrospective study. Front Med (Lausanne) 2022;9:975-80.
33. Desroches J, Roy M, Belliveau M, Leblanc B, Beaulieu P. PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study. Braz J Anesthesiol. 2020;70:333–42.
34. Hammas B, Thorn SE, Wattwil M. Superior prolonged antiemetic prophylaxis with a four-drug multimodal regimen: comparison with propofol or placebo. Acta Anaesthesiol Scand 2002;46:232–37.
35. Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003;97:62–71.
36. Jokela RM, Saarela TAK, Valanne JV, et al. Postoperative nausea and vomiting after sevoflurane with or without ondansetron compared with propofol in female patients undergoing breast surgery. Anesth Analg 2000;91:1062–65.
37. Karaca O, Pınar HU, Arpacı E, et al. The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: A prospective, randomised study. Anaesth Crit Care Pain Med. 2019;38:47-52.

Meme Cerrahisi Geçiren Hastalarda Uygulanan PECS II (pektoral sinir) Bloğunun İntraoperatif ve Postoperatif Etkileri

Yıl 2025, Cilt: 51 Sayı: 1, 51 - 58, 27.05.2025

Mustafa Naci Balıca , Duygu Karaköse Çalışkan , Selcan Yerebakan Akesen , Y. Gürkan Türker

https://doi.org/10.32708/uutfd.1580070

Öz

Meme cerrahisinde uygulanan PECS II (Pektoral Sinir) bloğun preoperatif ve postoperatif uygulanmasının, intraoperatif anestezik tüketimi ve postoperatif analjezik ihtiyacı ve komplikasyonların sıklığının değerlendirilmesini amaçladık. Meme cerrahisi geçirmiş 75 hastanın anestezi dökümlerinin retrospektif olarak incelenmesiyle ve verilerin analiziyle düzenlenmiştir. Verileri elde edilen hastalar üç gruba kategorize edilmiştir. Grup I (n25:genel anestezi uygulanan kontrol grubu), Grup II (n25:preoperatif PECS II blok ve genel anestezi) ve Grup III (n25: postoperatif PECS II blok ve genel anestezi). Verilerin analizi sonrası preoperatif PECS II blok uygulanan hastalarda intraoperatif desfluran MAC (minimum alveolar konsantrasyon) değerlerinin diğer gruplara göre belirgin olarak düştüğü bulunmuştur. İntraoperatif ve postoperatif PECS II blok uygulanan çalışma gruplarında, kontrol grubuna göre postoperatif analjezik tüketiminde ve ağrı skorlarında (erken dönem, postoperatif 0, 2, 4 ve 8. saat) anlamlı düşüşler görülmüştür. Preoperatif PECS II blok uygulanan grupta postoperatif ilk analjezik uygulama zamanı, sadece genel anestezi uygulanan ve Postoperatif PECS II blok uygulanan gruplardan anlamlı olarak daha geç bulunmuştur. Sadece genel anestezi uygulanan ve Postoperatif PECS II blok uygulanan gruplarda postoperatif ilk analjezik uygulama zamanı benzer bulunmuştur. Meme cerrahisi geçirecek hastalarda PECS II bloğun preoperatif veya postoperatif dönemde genel anesteziye eklenmesi hastalarda daha az ağrı ile seyreden postoperatif analjezi elde edilmesini sağlamaktadır. PECS II bloğun preoperatif uygulanmasının en önemli avantajı ise intraoperatif anestezik tüketimini azaltmasıdır.

Anahtar Kelimeler

Pektoral sinir bloğu, postoperatif analjezi, meme cerrahisi, rejyonal blok

Kaynakça

1. Poleshuck EL, Katz J, Andrus CH, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006;7:626–34.
2. Gärtner R, Jensen MB, Nielsen J, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302:85-92.
3. Blanco R. Bloqueo pectoral (Pecs Block). Manual de anestesia regionalye conoanatomía avanzada. Capítulo 4. Madrid: Editorial Ene; 2011;92-5.
4. Blanco R. The ‘pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011; 66:847-8.
5. Blanco R, Fajardo M, Maldonado TP. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59:470-75
6. Talbot H, Hutchinson SP, Edbrooke DL, Wrench I, Kohlhardt SR. Evaluation of a local anesthesia regimen after mastectomy. Anaesthesia 2004;59:664–67
7. Bashandy GMN, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Regional Anesthesia and Pain Medicine 2015; 40: 68–74.
8. Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anesthesia improves outcome after breast surgery. Ann Surg 1995;222:663-69.
9. Duff S, Connolly C, Buggy DJ. Adrenergic, inflammatory, and immune function in the setting of oncological surgery: their effects on cancer progression and the role of the anesthetic technique in their modulation. Int Anesthesiol Clin. 2016;54:48–57.
10. Iwasaki M, Zhao H, Jaffer T, et al. Volatile anaesthetics enhance the metastasis related cellular signalling including CXCR2 of ovarian cancer cells. Oncotarget. 2016;7:26042–56.
11. Connolly C, Buggy DJ. Opioids and tumour metastasis: does the choice of the anesthetic-analgesic technique influence outcome after cancer surgery? Curr Opin Anaesthesiol. 2016;29:468–74
12. Tripathy S , Rath S , Agrawal S, et al. Opioid-free anesthesia for breast cancer surgery: An observational study. J Anaesthesiol Clin Pharmacol. 2018;34:35-40.
13. Hassn AMA, Zanfaly HE, Biomy TA. Pre-emptive analgesia of ultrasound-guided pectoral nerve block II with dexmedetomidine–bupivacaine for controlling chronic pain after modified radical mastectomy. Research and Opinion in Anesthesia and Intensive Care 2016;3:6-13.
14. Kumar S, Goel D, Sharma SK, et al. A randomised controlled study of the post-operative analgesic efficacy of ultrasound-guided pectoral nerve block in the first 24 h after modified radical mastectomy. Indian Journal of Anaesthesia 2018;62:436-42.
15. Neethu M, Pandey RK, Sharma A, et al. Pectoral nerve blocks to improve analgesia after breast cancer surgery: A prospective, randomized and controlled trial. Journal of Clinical Anesthesia 2018;45:12–17.
16. Leite ALDS, Rocha FTR, Oliveira MJC, et al. Impact of Pectoralis Nerve Block (PECS) on postoperative pain in patients submitted to mastectomy with lymphadenectomy. Rev Col Bras Cir. 2022 Dec 12;49:e20223366.
17. Sun Q, Liu S , Wu H, et al. Clinical analgesic efficacy of pectoral nerve block in patients undergoing breast cancer surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99:e19614.
18. Versyck B, Van Geffen GJ, Van Houwe P. Prospective double blind randomized placebo-controlled clinical trial of the pectoral nerves (Pecs) block type II. Journal of Clinical Anesthesia 2017;40:46–50.
19. Kim DH, Kim S, Kim CS, et al. Efficacy of pectoral nerve block type II for breast-conserving surgery and sentinel lymph node biopsy: a prospective randomized controlled Study. Pain Research and Management 2018;20:1–8.
20. Wang K, Zhang X, Zhang T, et al. The Efficacy of Ultrasound-guided Type II Pectoral Nerve Blocks in Perioperative Pain Management for Immediate Reconstruction After Modified Radical Mastectomy. Clinical Journal of Pain 2018;34:231–36.
21. Wahba SS, Kamal SM. Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery. Egyptian Journal of Anaesthesia. 2014;30:129–35.
22. Hong B, Bang S, Oh C, Park E, Park S. Comparison of PECS II and erector spinae plane block for postoperative analgesia following modified radical mastectomy: Bayesian network meta-analysis using a control group. J Anesth. 2021;35:723–33.
23. Versyck B, Van Geffen GJ, Chin KJ. Analgesic efficacy of the Pecs II block: a systematic review and meta-analysis. Anaesthesia. 2019;74:663–73.
24. Senapathi TGA, Widnyana IMG, Aribawa IGNM, Jaya AAPS, Junaedi IMD. Combined ultrasound-guided Pecs II block and general anesthesia are effective for reducing pain from modified radical mastectomy. J Pain Res. 2019;12:1353–58.
25. De Cassai A, Bonanno C, Sandei L, et al. PECS II block is associated with lower incidence of chronic pain after breast surgery. Korean J Pain. 2019;32:286–91.
26. Zhao J, Han F, Yang Y, Li H, Li Z. Pectoral nerve block in anesthesia for modified radical mastectomy: a meta-analysis based on randomized controlled trials. Medicine (Baltimore) 2019;98:e15423.
27. Fancellu A, Perra T, Ninniri C, et al. The emerging role of pectoral nerve block (PECS block) in breast surgery: a case-matched analysis. Breast J. 2020;26:1784–87
28. Kurien RK, Salins SR, Jacob PM, Thomas K. Utility of Pecs block for perioperative opioid-sparing analgesia in cancer-related breast surgery: a randomized controlled trial. Indian J Surg Oncol. 2021;12:713–21.
29. Bakeer A, Abdallah NM. Erector spinae plane block versus PECS block type II for breast surgery: a randomized controlled trial. Anesth Pain Med. 2022;12:e122917.
30. Jin Z, Li R, Gan TJ, He Y, Lin J. Pectoral Nerve (PECs) block for postoperative analgesia-a systematic review and meta-analysis with trial sequential analysis. Int J Physiol Pathophysiol Pharmacol. 2020;12:40–50.
31. Kubodera K, Fujii T, Akane A, et al. Editors' Choice Efficacy of pectoral nerve block type-2 (Pecs II block) versus serratus plane block for postoperative analgesia in breast cancer surgery: a retrospective study. Nagoya J Med Sci. 2020;82:93–99.
32. Uribe AA, Weaver TE, Villalobos ME, et al. Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: a retrospective study. Front Med (Lausanne) 2022;9:975-80.
33. Desroches J, Roy M, Belliveau M, Leblanc B, Beaulieu P. PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study. Braz J Anesthesiol. 2020;70:333–42.
34. Hammas B, Thorn SE, Wattwil M. Superior prolonged antiemetic prophylaxis with a four-drug multimodal regimen: comparison with propofol or placebo. Acta Anaesthesiol Scand 2002;46:232–37.
35. Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003;97:62–71.
36. Jokela RM, Saarela TAK, Valanne JV, et al. Postoperative nausea and vomiting after sevoflurane with or without ondansetron compared with propofol in female patients undergoing breast surgery. Anesth Analg 2000;91:1062–65.
37. Karaca O, Pınar HU, Arpacı E, et al. The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: A prospective, randomised study. Anaesth Crit Care Pain Med. 2019;38:47-52.

Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Konular	Anesteziyoloji
Bölüm	Özgün Araştırma Makaleleri
Yazarlar	Mustafa Naci Balıca 0000-0002-7712-3872 Duygu Karaköse Çalışkan 0000-0003-0025-1478 Selcan Yerebakan Akesen 0000-0002-9518-541X Y. Gürkan Türker 0000-0002-3019-581X
Yayımlanma Tarihi	27 Mayıs 2025
Gönderilme Tarihi	5 Kasım 2024
Kabul Tarihi	17 Mart 2025
Yayımlandığı Sayı	Yıl 2025 Cilt: 51 Sayı: 1

Kaynak Göster

AMA	Balıca MN, Karaköse Çalışkan D, Yerebakan Akesen S, Türker YG. Meme Cerrahisi Geçiren Hastalarda Uygulanan PECS II (pektoral sinir) Bloğunun İntraoperatif ve Postoperatif Etkileri. Uludağ Tıp Derg. Mayıs 2025;51(1):51-58. doi:10.32708/uutfd.1580070

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ISSN: 1300-414X, e-ISSN: 2645-9027

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