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Published in: Aesthetic Plastic Surgery 1/2023

26-10-2022 | Breast Augmentation | Review

Analgesic Efficacy of Pectoral Nerve Blocks in Implant-Based Mammoplasty: A Systematic Review and Meta-Analysis

Authors: Ziying Zhang, Zhengyao Li, Zixuan Zhang, Xiaoyu Guan, Minqiang Xin

Published in: Aesthetic Plastic Surgery | Issue 1/2023

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Abstract

Objective

To evaluate the analgesic effect of pectoral nerve block in implant-based mammoplasty.

Methods

EMbase, PubMed, Web of science, MEDLINE, CNKI, Wanfang Database, VIP and other databases were searched from establishment to February 2022 by computer to collect randomized controlled trials which applied pectoral nerve block in implant-based mammoplasty, and meta-analysis was conducted after data extraction and quality evaluation of the literature meeting the inclusion criteria.

Results

A total of 336 patients in seven RCT studies were included in this study. Pectoral nerve block has a significant effect on postoperative analgesia in patients with implant-based mammoplasty with 1h VAS score significantly reduced in the resting state (MD=−1.85, 95%CI: −2.64~-1.07, P<0.00001); VAS score was significantly decreased 4–6 hours after operation (MD=−1.51, 95%CI: −2.47~−0.55, P=0.002); postoperative opioid consumption was reduced (SMD=−1.37, 95%CI: −2.51~−0.24, P=0.02) in PECS block group; and the incidence of postoperative nausea and vomiting in the PECS block group was significantly lower (RR: 0.30, 95 %CI: 0.19–0.38, P<0.00001).

Conclusions

The application of PECS block in submuscular implant-based mammoplasty can effectively reduce the degree of acute postoperative pain, opioid consumption and the incidence of postoperative nausea and vomiting, indicating its broad prospects in clinical application.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
go back to reference Melmed EP (1998) A review of explantation in 240 symptomatic women: a description of explantation and capsulectomy with reconstruction using a periareolar technique [J]. Plast Reconstr Surg 101:1364–1373CrossRefPubMed Melmed EP (1998) A review of explantation in 240 symptomatic women: a description of explantation and capsulectomy with reconstruction using a periareolar technique [J]. Plast Reconstr Surg 101:1364–1373CrossRefPubMed
2.
go back to reference Cooter RD, Rudkin GE, Gardiner SE (2007) Day case breast augmentation under paravertebral blockade: a prospective study of 100 consecutive patients [J]. Aesthet Plast Surg 31:666–673CrossRef Cooter RD, Rudkin GE, Gardiner SE (2007) Day case breast augmentation under paravertebral blockade: a prospective study of 100 consecutive patients [J]. Aesthet Plast Surg 31:666–673CrossRef
3.
go back to reference Wallace MS, Wallace AM, Lee J et al (1996) Pain after breast surgery: a survey of 282 women [J]. Pain 66:195–205CrossRefPubMed Wallace MS, Wallace AM, Lee J et al (1996) Pain after breast surgery: a survey of 282 women [J]. Pain 66:195–205CrossRefPubMed
4.
go back to reference Glare P, Aubrey KR, Myles PS (2019) Transition from acute to chronic pain after surgery [J]. Lancet (Lond, Engl) 393:1537–1546CrossRef Glare P, Aubrey KR, Myles PS (2019) Transition from acute to chronic pain after surgery [J]. Lancet (Lond, Engl) 393:1537–1546CrossRef
5.
go back to reference Williams L, Iteld L (2021) Moving toward opioid-free breast surgery: regional blocks and a novel technique [J]. Clin Plast Surg 48:123–130CrossRefPubMed Williams L, Iteld L (2021) Moving toward opioid-free breast surgery: regional blocks and a novel technique [J]. Clin Plast Surg 48:123–130CrossRefPubMed
6.
go back to reference Blanco R (2011) The “pecs block”: a novel technique for providing analgesia after breast surgery [J]. Anaesthesia 66:847–848CrossRefPubMed Blanco R (2011) The “pecs block”: a novel technique for providing analgesia after breast surgery [J]. Anaesthesia 66:847–848CrossRefPubMed
7.
go back to reference Blanco R, Fajardo M, Parras Maldonado T (2012) Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery [J]. Revista Espaola De Anestesiología Y Reanimación 59:470–475CrossRef Blanco R, Fajardo M, Parras Maldonado T (2012) Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery [J]. Revista Espaola De Anestesiología Y Reanimación 59:470–475CrossRef
8.
go back to reference Blanco R, Parras T, Mcdonnell JG et al (2013) Serratus plane block: a novel ultrasound-guided thoracic wall nerve block [J]. Anaesthesia 68:1107–1113CrossRefPubMed Blanco R, Parras T, Mcdonnell JG et al (2013) Serratus plane block: a novel ultrasound-guided thoracic wall nerve block [J]. Anaesthesia 68:1107–1113CrossRefPubMed
9.
go back to reference Lanier ST, Lewis C, Kendall MC et al (2018) Intraoperative nerve blocks fail to improve quality of recovery after tissue expander breast reconstruction: a prospective, double-blinded, randomized, placebo-controlled clinical trial [J]. Plast Reconstr Surg 141:590–597CrossRefPubMed Lanier ST, Lewis C, Kendall MC et al (2018) Intraoperative nerve blocks fail to improve quality of recovery after tissue expander breast reconstruction: a prospective, double-blinded, randomized, placebo-controlled clinical trial [J]. Plast Reconstr Surg 141:590–597CrossRefPubMed
10.
go back to reference Desroches J, Belliveau M, Bilodeau C et al (2018) Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes: a prospective volunteer randomized-controlled double-blind study [J]. Canad J Anesth 65:806–812CrossRef Desroches J, Belliveau M, Bilodeau C et al (2018) Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes: a prospective volunteer randomized-controlled double-blind study [J]. Canad J Anesth 65:806–812CrossRef
11.
go back to reference Ciftci B, Ekinci M, Celik EC et al (2021) Ultrasound-guided pectoral nerve block for pain control after breast augmentation: a randomized clinical study [J]. Braz J Anesthesiol 71:44–49PubMed Ciftci B, Ekinci M, Celik EC et al (2021) Ultrasound-guided pectoral nerve block for pain control after breast augmentation: a randomized clinical study [J]. Braz J Anesthesiol 71:44–49PubMed
12.
go back to reference Desroches J, Roy M, Belliveau M et al (2020) PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study[J]. Braz J Anesthesiol 70:333–342CrossRefPubMedPubMedCentral Desroches J, Roy M, Belliveau M et al (2020) PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study[J]. Braz J Anesthesiol 70:333–342CrossRefPubMedPubMedCentral
13.
go back to reference Ekinci M, Ciftci B, Celik EC et al (2019) The efficacy of different volumes on ultrasound-guided type-I pectoral nerve block for postoperative analgesia after subpectoral breast augmentation: a prospective, randomized, controlled study [J]. Aesthet Plast Surg 43:297–304CrossRef Ekinci M, Ciftci B, Celik EC et al (2019) The efficacy of different volumes on ultrasound-guided type-I pectoral nerve block for postoperative analgesia after subpectoral breast augmentation: a prospective, randomized, controlled study [J]. Aesthet Plast Surg 43:297–304CrossRef
14.
go back to reference Karaca O, Pınar HU, Arpacı E et al (2019) The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: a prospective, randomised study [J]. Anaesth Crit Care Pain Med 38:47–52CrossRefPubMed Karaca O, Pınar HU, Arpacı E et al (2019) The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: a prospective, randomised study [J]. Anaesth Crit Care Pain Med 38:47–52CrossRefPubMed
15.
go back to reference Schuitemaker RJB, Sala-Blanch X, Sanchez Cohen AP et al (2019) Analgesic efficacy of modified pectoral block plus serratus plane block in breast augmentation surgery: a randomised, controlled, triple-blind clinical trial [J]. Revista Espanola De Anestesiologia Y Reanimacion 66:62–71 Schuitemaker RJB, Sala-Blanch X, Sanchez Cohen AP et al (2019) Analgesic efficacy of modified pectoral block plus serratus plane block in breast augmentation surgery: a randomised, controlled, triple-blind clinical trial [J]. Revista Espanola De Anestesiologia Y Reanimacion 66:62–71
16.
go back to reference Wang K, Zhang X, Zhang T et al (2018) The efficacy of ultrasound-guided type II pectoral nerve blocks in perioperative pain management for immediate reconstruction after modified radical mastectomy: a prospective, randomized study [J]. Clin J Pain 34:231–236CrossRefPubMed Wang K, Zhang X, Zhang T et al (2018) The efficacy of ultrasound-guided type II pectoral nerve blocks in perioperative pain management for immediate reconstruction after modified radical mastectomy: a prospective, randomized study [J]. Clin J Pain 34:231–236CrossRefPubMed
17.
go back to reference Chen X (2021) Analgesic effect of pectoral nerves I combined with serratus anterior continuous block after breast prosthesis implantation [D]. Dalian Medical University, Dalian, China Chen X (2021) Analgesic effect of pectoral nerves I combined with serratus anterior continuous block after breast prosthesis implantation [D]. Dalian Medical University, Dalian, China
18.
go back to reference Kokosis G, Chopra K, Darrach H et al (2019) Re-visiting post-breast surgery pain syndrome: risk factors, peripheral nerve associations and clinical implications [J]. Gland Surg 8:407–415CrossRefPubMedPubMedCentral Kokosis G, Chopra K, Darrach H et al (2019) Re-visiting post-breast surgery pain syndrome: risk factors, peripheral nerve associations and clinical implications [J]. Gland Surg 8:407–415CrossRefPubMedPubMedCentral
20.
go back to reference Ducic I, Seiboth LA, Iorio ML (2011) Chronic postoperative breast pain: danger zones for nerve injuries [J]. Plast Reconstr Surg 127:41–46CrossRefPubMed Ducic I, Seiboth LA, Iorio ML (2011) Chronic postoperative breast pain: danger zones for nerve injuries [J]. Plast Reconstr Surg 127:41–46CrossRefPubMed
21.
go back to reference Poleshuck EL, Katz J, Andrus CH et al (2006) Risk factors for chronic pain following breast cancer surgery: a prospective study [J]. J Pain 7:626–634CrossRefPubMedPubMedCentral Poleshuck EL, Katz J, Andrus CH et al (2006) Risk factors for chronic pain following breast cancer surgery: a prospective study [J]. J Pain 7:626–634CrossRefPubMedPubMedCentral
22.
go back to reference Nikolajsen L, Brandsborg B, Lucht U et al (2006) Chronic pain following total hip arthroplasty: a nationwide questionnaire study [J]. Acta Anaesth Scand 50:495–500CrossRefPubMed Nikolajsen L, Brandsborg B, Lucht U et al (2006) Chronic pain following total hip arthroplasty: a nationwide questionnaire study [J]. Acta Anaesth Scand 50:495–500CrossRefPubMed
23.
go back to reference Voscopoulos C, Lema M (2010) When does acute pain become chronic? [J]. Br J Anaesth 105(Suppl 1):i69-85CrossRefPubMed Voscopoulos C, Lema M (2010) When does acute pain become chronic? [J]. Br J Anaesth 105(Suppl 1):i69-85CrossRefPubMed
24.
go back to reference Kryger ZB, Rawlani V, Lu L et al (2008) Decreased postoperative pain, narcotic, and antiemetic use after breast reduction using a local anesthetic pain pump [J]. Ann Plast Surg 61:147–152CrossRefPubMed Kryger ZB, Rawlani V, Lu L et al (2008) Decreased postoperative pain, narcotic, and antiemetic use after breast reduction using a local anesthetic pain pump [J]. Ann Plast Surg 61:147–152CrossRefPubMed
25.
go back to reference Rawlani V, Kryger ZB, Lu L et al (2008) A local anesthetic pump reduces postoperative pain and narcotic and antiemetic use in breast reconstruction surgery: a randomized controlled trial [J]. Plast Reconstr Surg 122:39–52CrossRefPubMed Rawlani V, Kryger ZB, Lu L et al (2008) A local anesthetic pump reduces postoperative pain and narcotic and antiemetic use in breast reconstruction surgery: a randomized controlled trial [J]. Plast Reconstr Surg 122:39–52CrossRefPubMed
26.
go back to reference Nadeau MH, Saraswat A, Vasko A et al (2016) Bupivacaine versus liposomal bupivacaine for postoperative pain control after augmentation mammaplasty: a prospective, randomized, double-blind trial [J]. Aesthet Surg J 36:Np47-52CrossRefPubMed Nadeau MH, Saraswat A, Vasko A et al (2016) Bupivacaine versus liposomal bupivacaine for postoperative pain control after augmentation mammaplasty: a prospective, randomized, double-blind trial [J]. Aesthet Surg J 36:Np47-52CrossRefPubMed
27.
go back to reference Shah A, Rowlands M, Krishnan N et al (2015) Thoracic intercostal nerve blocks reduce opioid consumption and length of stay in patients undergoing implant-based breast reconstruction [J]. Plast Reconstr Surg 136:584e–591eCrossRefPubMed Shah A, Rowlands M, Krishnan N et al (2015) Thoracic intercostal nerve blocks reduce opioid consumption and length of stay in patients undergoing implant-based breast reconstruction [J]. Plast Reconstr Surg 136:584e–591eCrossRefPubMed
28.
go back to reference Winocour S, Murad MH, Bidgoli-Moghaddam M et al (2014) A systematic review of the use of Botulinum toxin type A with subpectoral breast implants [J]. J Plast Reconstr Aesthet Surg JPRAS 67:34–41CrossRefPubMed Winocour S, Murad MH, Bidgoli-Moghaddam M et al (2014) A systematic review of the use of Botulinum toxin type A with subpectoral breast implants [J]. J Plast Reconstr Aesthet Surg JPRAS 67:34–41CrossRefPubMed
29.
go back to reference Durán-Vega HC, Ramírez-Montañana A, Gonzalez Galindo O et al (2018) Ropivacaine in breast augmentation surgery [J]. Plast Reconstr Surg Glob Open 6:e1745CrossRefPubMedPubMedCentral Durán-Vega HC, Ramírez-Montañana A, Gonzalez Galindo O et al (2018) Ropivacaine in breast augmentation surgery [J]. Plast Reconstr Surg Glob Open 6:e1745CrossRefPubMedPubMedCentral
30.
go back to reference McCarthy CM, Pusic AL, Hidalgo DA (2009) Efficacy of pocket irrigation with bupivacaine and ketorolac in breast augmentation: a randomized controlled trial [J]. Ann Plast Surg 62:15–17CrossRefPubMed McCarthy CM, Pusic AL, Hidalgo DA (2009) Efficacy of pocket irrigation with bupivacaine and ketorolac in breast augmentation: a randomized controlled trial [J]. Ann Plast Surg 62:15–17CrossRefPubMed
31.
go back to reference Hards M, Harada A, Neville I et al (2016) The effect of serratus plane block performed under direct vision on postoperative pain in breast surgery [J]. J Clin Anesth 34:427–431CrossRefPubMed Hards M, Harada A, Neville I et al (2016) The effect of serratus plane block performed under direct vision on postoperative pain in breast surgery [J]. J Clin Anesth 34:427–431CrossRefPubMed
32.
go back to reference Abi-Rafeh J, Safran T, Abi-Jaoude J et al (2022) Nerve blocks in breast plastic surgery: outcomes, complications, and comparative efficacy. Plast Reconstr Surg 150(1):1e–12eCrossRefPubMed Abi-Rafeh J, Safran T, Abi-Jaoude J et al (2022) Nerve blocks in breast plastic surgery: outcomes, complications, and comparative efficacy. Plast Reconstr Surg 150(1):1e–12eCrossRefPubMed
Metadata
Title
Analgesic Efficacy of Pectoral Nerve Blocks in Implant-Based Mammoplasty: A Systematic Review and Meta-Analysis
Authors
Ziying Zhang
Zhengyao Li
Zixuan Zhang
Xiaoyu Guan
Minqiang Xin
Publication date
26-10-2022
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 1/2023
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-022-03135-8

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