Study evaluated PECS Block with levobupivacaine and Dexmedetomidine for Pain Control After Mastectomy: Study

Breast surgery's significant pain necessitates a substantial quantity of analgesics for postoperative pain relief. Recent study focused on postoperative pain management in female patients undergoing breast cancer surgery, particularly modified radical mastectomy (MRM). The researchers aimed to assess the effectiveness of the interfascial plane for the pectoral nerve (PECS) block, in combination with dexmedetomidine, in alleviating postoperative pain. The study involved 60 female patients who were randomized into two groups: one receiving 20 ml of 0.25% levobupivacaine (Group L) and the other receiving 20 ml of 0.25% levobupivacaine with 0.5 µg/kg of dexmedetomidine (Group DL). The primary outcome measured was the duration of analgesia.

Study Results

The results showed that the median time of the first analgesic requirement was 8 hours in Group L and 18 hours in Group DL, with a significant difference (P < 0.001). The mean total opioid consumption in the first 24 hours was 12.53 mg in Group L and 6.93 mg in Group DL. The study concluded that adding dexmedetomidine to levobupivacaine enhanced the duration of analgesia of direct PECS block in patients undergoing MRM, leading to extended postoperative analgesia and reduced opioid consumption.

Significance of PECS Block and Dexmedetomidine

The study highlighted the significance of PECS block in postoperative pain management for breast surgery, providing effective analgesia without significant side effects. It also pointed out the potential benefits of using dexmedetomidine as an adjuvant with levobupivacaine, including prolonged analgesia, reduced opioid consumption, and improved quality of postoperative analgesia. The findings suggested that dexmedetomidine enhances the effect of PECS block, and its addition can lead to more consistent and predictable analgesic outcomes.

Study Limitations and Recommendations

The study's limitations included the absence of a passive control group and the use of the Numerical Rating Scale (NRS) score for pain assessment, which may be less accurate than the minimal clinically significant difference (MCID) in evaluating change in postoperative pain. The study recommended future clinical trials to evaluate the benefits and drawbacks of continuous, direct PECS block after placing an epidural catheter in the fascial plane and to assess the quality of recovery (QoR) score. The authors also suggested further research to determine whether a lesser volume can produce effective analgesia in direct PEC block and to explore the multifaceted benefits of direct PECS block.

Overall, the study provided valuable insights into postoperative pain management in female patients undergoing breast cancer surgery and emphasized the potential of using dexmedetomidine as an adjuvant with levobupivacaine for enhancing the efficacy of PECS block in alleviating postoperative pain.

Key Points -

- The study focused on postoperative pain management in female patients undergoing breast cancer surgery, specifically modified radical mastectomy (MRM). It aimed to assess the effectiveness of the interfascial plane for the pectoral nerve (PECS) block, combined with dexmedetomidine, in alleviating postoperative pain. The study involved 60 female patients randomized into two groups: one receiving 0.25% levobupivacaine and the other receiving the same with dexmedetomidine.

- Results showed that the median time of the first analgesic requirement was significantly longer in the Group receiving dexmedetomidine, with a mean total opioid consumption in the first 24 hours also being significantly lower in this group. The study concluded that adding dexmedetomidine to levobupivacaine enhanced the duration of analgesia of direct PECS block in patients undergoing MRM, leading to extended postoperative analgesia and reduced opioid consumption.

- The study highlighted the significance of PECS block in postoperative pain management for breast surgery, providing effective analgesia without significant side effects. It also pointed out the potential benefits of using dexmedetomidine as an adjuvant with levobupivacaine, including prolonged analgesia, reduced opioid consumption, and improved quality of postoperative analgesia. The findings suggested that dexmedetomidine enhances the effect of PECS block, and its addition can lead to more consistent and predictable analgesic outcomes. The study recommended future clinical trials to evaluate the benefits and drawbacks of continuous, direct PECS block after placing an epidural catheter in the fascial plane and to assess the quality of recovery (QoR) score.

Reference –

Arun N, Avinash R, Choudhary A. Intraoperative thoracic interfascial plane block with levobupivacaine versus levobupivacaine with dexmedetomidine for postoperative

analgesia after modified radical mastectomy: A randomised controlled double‑blinded trial. Indian J Anaesth 2024;68:686‑92