Newly Published
Pain Medicine  |   June 2019
Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery: A Systematic Review and Meta-analysis
Author Notes
  • From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio (N.H., N.K., M.E.); Department of Anesthesiology, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada (R.B.); Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (C.J.L.M., P.W., T. Sullivan, F.W.A.); The Ohio State University College of Medicine, Columbus, Ohio (N.K.); Central Michigan University College of Medicine, Mt. Pleasant, Michigan (T. Sawyer); and Department of Anesthesia, and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (F.W.A.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication October 10, 2018. Accepted for publication April 30, 2019.
    Submitted for publication October 10, 2018. Accepted for publication April 30, 2019.×
  • Correspondence: Address correspondence to Dr. Abdallah: The Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, Ontario, Canada, K1H 8L6. FAbdallah@toh.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pain Medicine / Pain Medicine / Opioid
Pain Medicine   |   June 2019
Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery: A Systematic Review and Meta-analysis
Anesthesiology Newly Published on June 28, 2019. doi:10.1097/ALN.0000000000002822
Anesthesiology Newly Published on June 28, 2019. doi:10.1097/ALN.0000000000002822
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Pectoralis-II block is a potential alternative to paravertebral blocks to provide regional analgesia for breast cancer surgery

What This Article Tells Us That Is New:

  • This meta-analysis includes 14 randomized trials comparing pectoralis-II block with paravertebral blocks and found that there were no differences in pain scores or opioid consumption between the two groups in patients having surgery for breast cancer

  • Petoralis-II blocks were noninferior to paravertebral blocks in reducing pain intensity and morphine consumption for the first 24 h after surgery and both were superior to systemic analgesia alone

Background: Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery.

Methods: Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling.

Results: Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of −30.5 mg [−42.2, −18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by −4.7cm · h [−5.1, −4.2] or −1.2cm [−1.3, −1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes.

Conclusions: We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.