Is COMBIPECS the answer to perioperative analgesia for breast surgery? A double blinded randomized controlled trial.

BACKGROUND AND AIMS: Pecs block and its variations provides perioperative analgesia, reduce PONV and other opioid related side effects. We hypothesized that COMIBPES block in addition to general anaesthesia will provide better postoperative analgesia when compared to general anaesthesia alone in breast cancer surgery patients. METHODS: After obtaining permission from the institutional review board and registering the trial with Clinical Trials Registry of India (CTRI), we conducted a double blinded randomized controlled trial of 100 patients posted for elective breast surgery with axillary dissection. Patients were divided into two groups, P (Pecs block) and C (control). Intraoperative analgesia, postoperative analgesia, postoperative nausea vomiting (PONV) and shoulder mobility on first postoperative day (POD1) were noted. Primary outcomes were the pain scores measured by visual analog scale (VAS) and cumulative intravenous morphine consumption from patient controlled analgesia (PCA) pump at measurement intervals of 0, 1, 4, 8, 12 and 24 hours postoperatively. RESULTS: Intraoperatively, Group P patients did not require any additional analgesia, whereas all the patients in Group C required additional intraoperative morphine (mean, SD: 5.12, 2.63 mg, compared to nil in group P, P< 0.01). COMBIPECS block group had lower pain scores and PCA morphine requirements, less PONV and better shoulder mobility on POD1. CONCLUSION: COMBIPECS block is a valuable addition to general anaesthesia for breast cancer surgery as it reduces pain and PONV while allowing better postoperative shoulder mobility.

Ultrasound-guided modified serratus anterior plane block for perioperative analgesia in breast oncoplastic surgery: A case series.

Ultrasound-guided serratus anterior plane (SAP) block has been described to provide complete anaesthesia and analgesia to the lateral thoracic wall. Its use has been recently reported in breast reconstruction surgeries. We present a series of 11 patients where ultrasound-guided SAP block was used as part of multimodal analgesia in breast reconstruction surgery using latissimus dorsi (LD) myocutaneous flap after mastectomies. This resulted in excellent analgesia in the perioperative period and minimal use of intravenous analgesics. The SAP block technique described here is safe and also provides effective analgesia in breast reconstruction surgery with LD flap.

COMBIPECS, the single-injection technique of pectoral nerve blocks 1 and 2: a case series.

Ultrasound-guided Pecs block can provide perioperative analgesia for breast surgery. A single-injection technique (COMBIPECS) combines both Pecs 1 and Pecs 2 blocks in a single needle pass. This technique saves time and is equally effective as the modified Pecs block which uses 2 needle passes. We present a case series of 21 patients who received the COMBIPECS block as a part of multimodal analgesia for breast cancer surgery. The block was administered before the surgery after induction of general anesthesia. The patients needed minimal intraoperative analgesics and remained pain free in the postoperative period up to 24 hours after surgery.

Hickman to central venous catheter: A case of difficult venous access in a child suffering from acute lymphoblastic leukemia.

Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed.

Ultrasound-Guided Serratus Anterior Plane Block in Breast Reconstruction Surgery.

Pecs block and its variations have been used for various breast surgeries. We describe 2 cases of mastectomy and breast reconstruction by latissimus dorsi (LD) flap where regional analgesia was provided by a combination of ultrasound-guided Pecs-I block and serratus anterior plane block, a recently described technique in which local anesthetic is deposited in the plane between the LD and serratus anterior muscle. This resulted in excellent intraoperative and postoperative analgesia and a minimum of systemic analgesics. The described technique is safe to administer and provides good analgesia for breast reconstruction surgery by LD flap.