Effect of Pectoralis Block on Analgesia After Simple Mastectomy

The pectoralis block, including pecs I and II block, is a novel technique first described in 2011 as an alternative to paravertebral blockade for analgesia following breast surgery. The concept involves injecting local anesthetic near the coracoid process in the fascial planes between both the pectoralis major and minor muscles (pecs I), and the fascial plane between the pectoralis minor and serratus anterior muscles (pecs II). This is a prospective, double-blinded, randomized controlled trial in subjects undergoing mastectomy under general anesthesia. The research goal is to determine the efficacy of the pectoralis block compared to placebo in improving quality of recovery following mastectomy.

• Pectoralis block (Procedure): Pectoralis block involving injection near the coracoid process in the fascial planes between both the pectoralis major and minor muscles (pecs I), and the fascial plane between the pectoralis minor and serratus anterior muscles (pecs II).
• Normal saline injection (Drug): Pectoralis block involving injection of normal saline 30ml near the coracoid process in the fascial planes between both the pectoralis major and minor muscles (pecs I), and the fascial plane between the pectoralis minor and serratus anterior
• Ropivacaine Injection (Drug): Pectoralis block involving injection of ropivacaine injection 30ml of 0,25% (75 mg) near the coracoid process in the fascial planes between both the pectoralis major and minor muscles (pecs I), and the fascial plane between the pectoralis minor and serratus anterior

Primary outcomes

• Quality of Recovery-27 score at baseline [Baseline]: Quality of Recovery-27 score, a validated tool to assess quality of postoperative recovery at baseline
• Quality of Recovery-27 score at post operative day 1 [Post operative day 1]: Quality of Recovery-27 score, a validated tool to assess quality of postoperative recovery, at baseline and post operative day 1
• Quality of Recovery-27 scores at post operative day 7 [Post operative day 7]: Quality of Recovery-27 score, a validated tool to assess quality of postoperative recovery, at baseline and post operative day 7
• Quality of Recovery-27 scores at post operative day 30 [Post operative day 30]: Quality of Recovery-27 score, a validated tool to assess quality of postoperative recovery, at baseline and post operative day 30
• Quality of Recovery-27 scores at post operative day 90 [Post operative day 90]: Quality of Recovery-27 score, a validated tool to assess quality of postoperative recovery, at baseline and post operative day 90

Secondary outcomes

• Comparison of Numerical Rating Scale-11 (NRS-11) at rest [90 days]: Comparison of patient reported pain assessment while at rest using the NRS-11 Scale at arrival in PACU, 15 minutes, 30 minutes, 1 hour and 2 hours after arrival in PACU, and postoperative days 1, 7, 30, and 90. The NRS-11 is a 11 point scale when 0 is no pain and 10 is severe pain.
• Comparison of Numerical Rating Scale-11 (NRS-11) with movement [90 days]: Comparison of patient reported pain assessment while with movement using the NRS-11 Scale at arrival in PACU, 15 minutes, 30 minutes, 1 hour and 2 hours after arrival in PACU, and postoperative days 1, 7, 30, and 90. The NRS-11 is a 11 point scale when 0 is no pain and 10 is severe pain.
• Duration of postoperative analgesia [Up to 24 hours]: Duration of postoperative analgesia as measured by time in minutes to first intravenous or oral opioid postoperatively.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* ASA 1, 2, and 3 patients (According to ASA classification of comorbid conditions and general health)
* Patients undergoing simple mastectomy

Exclusion Criteria:

* -Patient Refusal
* Allergy to local anesthetics
* Inability to communicate in English
* Use of 8 mg morphine equivalents or greater currently and for a period of longer then 2 weeks prior to surgery
* Existing nerve injuries or sensory deficits
* Conversion to anesthesia via an endotracheal tube

• Uma Shastri, MD, Principal investigator, Vanderbilt University Medical Center