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ESRA19-0201 Is combipecs (PECS1&2) the answer to perioperative analgesia for breast surgery? A randomized controlled trial
  1. R Khemka Mittal1,
  2. A Chakraborty1,
  3. R Ahmed2 and
  4. S Agarwal2
  1. 1Tata Medical Center, Department of Anaesthesia and Critical Care, Kolkata, India
  2. 2Tata Medical Center, Department of Breast Oncosurgery, Kolkata, India


Background and aims Pecs block and its variations have become popular among anesthesiologists. While it provides perioperative analgesia, it also helps to reduce postoperative nausea vomiting (PONV) and other opioid related side effects. Earlier we had described a single injection technique of Pecs block, COMBIPECS. We present here a clinical study to assess the effectiveness of the block in breast cancer surgery.

Methods We conducted an observer blinded randomized controlled trial of 100 patients posted for elective breast surgery with axillary dissection, who were divided into two groups, P (Pecs block) and C (control). Intraoperative analgesia, postoperative analgesia, PONV and shoulder mobility on first postoperative day (POD1) were noted. Primary outcomes were the pain scores measured by visual analog scale (VAS) and cumulative intravenous morphine consumption from patient controlled analgesia (PCA) pump at measurement intervals of 0, 1, 4, 8, 12 and 24 hours postoperatively.

Results Intraoperatively, Group P patients did not require any additional analgesia, whereas all the patients in Group C required additional intraoperative morphine (mean, SD: 5.12, 2.63 mg, P<0.01). COMBIPECS block group had lower pain scores and PCA morphine requirements, less PONV and better shoulder mobility on POD1.

Abstract ESRA19-0201 Figure 1

A) Mean pain scores at sudied intervals. Note that the difference is maximum in first hour and then wanes off gradually; B) PCA morphine cumulartive readings (mean) at measuring intervals. Note that the difference remains similar from 12 hours onwards.

Conclusions We chose a uniform surgical subset, implemented double blinding and provided PCA to all patients from post anesthesia care unit to 24 hours postoperatively. We concluded that COMBIPECS block is a valuable addition to general anesthesia for breast cancer surgery as it reduces pain and PONV while allowing better postoperative shoulder mobility.

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