• Alaa Ahmed Elshanbary, Mohamed Sayed Zaazouee, Youssef Bahaaeldin Darwish, Maha Jabir Omran, Alaa Yousry Elkilany, Mohamed Salah Abdo, Ayat M Saadeldin, Sherouk Elkady, Anas Zakarya Nourelden, and Khaled Mohamed Ragab.
• Faculty of Medicine, Alexandria University, Alexandria.
• Clin J Pain. 2021 Dec 1; 37 (12): 925939925-939.

ObjectiveWe aimed to compare the safety and efficacy of pectoral nerve block (Pecs) I and II with control or other techniques used during breast cancer surgeries such as local anesthesia, paravertebral block, and erector spinae plane block (ESPB).MethodsWe searched 4 search engines (PubMed, Cochrane Library, Scopus, and Web of Science) for relevant trials, then extracted the data and combined them under random-effect model using Review Manager Software.ResultsWe found 47 studies, 37 of them were included in our meta-analysis. Regarding intraoperative opioid consumption, compared with control, a significant reduction was detected in Pecs II (standardized mean difference [SMD]=-1.75, 95% confidence interval [CI] [-2.66, -0.85], P=0.0001) and Pecs I combined with serratus plane block (SMD=-0.90, 95% CI [-1.37, -0.44], P=0.0002). Postoperative opioid consumption was significantly lowered in Pecs II (SMD=-2.28, 95% CI [-3.10, -1.46], P<0.00001) compared with control and Pecs II compared with ESPB (SMD=-1.75, 95% CI [-2.53, -0.98], P<0.00001). Furthermore, addition of dexmedetomidine to Pecs II significantly reduced postoperative opioid consumption compared with Pecs II alone (SMD=-1.33, 95% CI [-2.28, -0.38], P=0.006).ConclusionPecs block is a safe and effective analgesic procedure during breast cancer surgeries. It shows lower intra and postoperative opioid consumption than ESPB, and reduces pain compared with control, paravertebral block, and local anesthesia, with better effect when combined with dexmedetomidine.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

11 keywords...

hide…