Author(s): Summer Hassan, Claudia Paterson, Rana Alsadat, Garth Poole
Purpose: Mastectomy is a life-altering physical and psychological event for patients. Suboptimal management of immediate postoperative pain increases the risk of post-mastectomy pain syndrome. PECs II block is a regional analgesic technique expected to anesthetize the lateral chest wall. We propose an intraoperative surgeon-delivered modification to the PECs II block to improve the quality of recovery. Objective: To develop a reproducible, efficient, safe intraoperative field block, and to assess its efficacy by pain scores and opiate consumption. Patients and methods: The SCB was performed on 96 consecutive patients undergoing mastectomy by a single surgeon from 2020 to 2021. The block consisted of 40 ml of bupivacaine given under direct vision to five areas: pectoralis major, the interjectorily groove, pectoralis minor lateral intercostal nerves with the nerve to serratus anterior, and the medial cutaneous nerves. Patients were assessed using visual analogue pain scale from 0-10 for movement and at rest at 1,3,6,12, and 24 hours. Rescue analgesia was freely given, and the total requirements were obtained from patient notes. Results: The median pain score at rest and with movement at 1 h was 0 out of 10. The median pain score at 3 h, at rest and movement, were 1 and 2, respectively. Only 28.1% of patients required second-line analgesia within the first 24 hours with average commencement at 4.8 hours. Total opioid consumption was minimal, averaging 0.42 mg of Oxynorm, 1.3 mg of Oxycodone, 1.8 mg of Sevredol, and 3.07 mg of Morphine. Only 12.5% of patients required a short course of opioids on discharge, and none returned to theatre or required pain-related readmission. Conclusion: The SCB is a simple and effective technique to minimize post-mastectomy pain.
