The role of pectoral nerve blocks in a day-case mastectomy service: A prospective cohort study.

BACKGROUND: It is now recognised that the majority of breast surgery can be safely undertaken as day case procedures. We aimed to evaluate the effect of pectoral nerve (Pecs2) blocks on recovery parameters and day case rates in patients undergoing mastectomy for breast cancer. METHODS: A prospective cohort study was performed in a single NHS Foundation trust between 1st April 2014 and 31st December 2016. Visual analogue scale (VAS) pain scores (0-10) at 4 and 8 h, episodes of post-operative nausea ±â€¯vomiting (PONV), opioid use and day case outcome were compared between Pecs2 and no Pecs2 groups. RESULTS: 22 patients underwent general anaesthesia (GA) + Pecs2 block and 30 GA ± local anaesthetic infiltration.Mean pain scores were significantly lower in the Pecs2 (2.5) vs no Pecs2 (4.6) group at 4 h (p = 0.0132) and 8 h, Pecs2 (1.9) vs no Pecs2 (3.6) (p = 0.0038).Episodes of PONV requiring additional anti-emetic were lower and statistically significant in the Pecs2 group (2/22, 9%) than the no Pecs2 group (14/30, 46%), (p = 0.005).Additional opioid use was significantly lower in the Pecs2 group (4/22, 18%) than in the no Pecs2 group (14/30, 46%) (p = 0.0423).18 patients in the Pecs2 group were discharged the same day in contrast to just 3 patients in the no Pecs2 group. This was highly statistically significant (p = 0.0001). CONCLUSIONS: Pecs2 blocks can significantly reduce post-operative pain, nausea and vomiting in patients undergoing mastectomy. Their use can enable units to achieve high day-case mastectomy rates.

Incidental breast cancers identified in the one-stop symptomatic breast clinic.

PURPOSE: Breast cancers can be asymptomatic at an early stage and hence screening programmes play an important role in detecting breast cancers early. Even in those patients who present with breast symptoms, breast cancers may be present at a site remote to the site of symptoms. In this study, we aimed to assess the frequency, site and imaging modality used to identify these incidental cancers in the symptomatic one-stop breast clinic. METHODS: All patients who were seen in our breast clinic with breast symptoms over a two-year period were included in the study. We correlated the presenting symptoms of patients diagnosed with breast cancer with imaging (mammogram and ultrasound) findings. Incidental cancers were defined as "histologically confirmed breast cancers which were impalpable, remote to the site of symptoms and only identified on imaging." RESULTS: In the study period, 281 women were diagnosed with breast cancer out of 4,400 patients seen at the one-stop breast clinic. Thirty six patients (12.8%) diagnosed with breast cancer had an incidental cancer which was only identified by imaging. The majority of contralateral, incidental cancers were identified by both mammography and ultrasound (US) and patients were all above 35 years. CONCLUSION: We suggest mammography of both breasts and US of the symptomatic breast in order to identify incidental cancers.