Journal article
The Use of Pectoralis Blocks in Breast Surgery: A Practice Advisory and Narrative Review from the Society for Ambulatory Anesthesia (SAMBA)
Annals of surgical oncology, Vol.29(8), pp.4777-4786
04/15/2022
DOI: 10.1245/s10434-022-11724-9
PMID: 35428960
Abstract
Although pectoralis (PECS) blocks are commonly used for breast surgery, recommendations regarding the efficacy of these blocks have thus far not been developed by any professional anesthesia society. Given the potential impact of PECS blocks on analgesia after outpatient breast surgery, The Society for Ambulatory Anesthesia (SAMBA) convened a task force to develop a practice advisory on the use of this analgesic technique. In this practice advisory, we compare the efficacy of PECS blocks with systemic analgesia, local infiltration anesthesia, and paravertebral blockade. Our objectives were to advise on two clinical questions. (1) Does PECS-1 and/or -2 blockade provide more effective analgesia for breast-conserving surgery than either systemic analgesics or surgeon-provided local infiltration anesthesia? (2) Does PECS-1 and/or -2 blockade provide equivalent analgesia for mastectomy compared with a paravertebral block (PVB)? Among patients undergoing breast-conserving surgery, PECS blocks moderately reduce postoperative opioid use, prolong time to analgesic rescue, and decrease postoperative pain scores when compared with systemic analgesics. SAMBA recommends the use of a PECS-1 or -2 blockade in the absence of systemic analgesia (Strength of Recommendation A). No evidence currently exists that strongly favors the use of PECS blocks over surgeon-performed local infiltration in this surgical population. SAMBA cannot recommend PECS blocks over surgical infiltration (Strength of Recommendation C). For patients undergoing a mastectomy, a PECS block may provide an opioid-sparing effect similar to that achieved with PVB; SAMBA recommends the use of a PECS block if a patient is unable to receive a PVB (Strength of Recommendation A).
Details
- Title: Subtitle
- The Use of Pectoralis Blocks in Breast Surgery: A Practice Advisory and Narrative Review from the Society for Ambulatory Anesthesia (SAMBA)
- Creators
- Alberto E. Ardon - Mayo Clinic in FloridaJohn E. George - Cleveland ClinicKapil Gupta - Vardhman Mahavir Medical College & Safdarjung HospitalMichael J. O'Rourke - Edward Hines, Jr. VA HospitalMelinda S. Seering - University of IowaHanae K. Tokita - Memorial Sloan Kettering Cancer CenterSylvia H. Wilson - Medical University of South CarolinaTracy-Ann Moo - Memorial Sloan Kettering Cancer CenterIngrid Lizarraga - University of IowaSarah McLaughlin - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA.Roy A. Greengrass - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA.
- Resource Type
- Journal article
- Publication Details
- Annals of surgical oncology, Vol.29(8), pp.4777-4786
- Publisher
- Springer Nature
- DOI
- 10.1245/s10434-022-11724-9
- PMID
- 35428960
- ISSN
- 1068-9265
- eISSN
- 1534-4681
- Number of pages
- 10
- Language
- English
- Date published
- 04/15/2022
- Academic Unit
- Surgery; Anesthesia
- Record Identifier
- 9984296146702771
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