Martsiniv V. V., Loskutov O. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Abstract. Background. Chronic pain after breast cancer surgery is a significant medical problem. Still, it’snot clear how myofascial blocks, especially pectoral nerve block type-II, affect on the emerging of post-mastectomy pain syndrome (PMPS). Aim of this study is to compare efficacy of the pectoral nerve block type II, paravertebral block and systemic analgesia in relation to prevalence and severity of the PMPS after breast cancer surgery. Materials and methods. Ninety-one adult women after unilateral radical mastectomy or quadrantectomy with axillary dissection were enrolled in one-center randomized prospective study. They were allocated into three groups depending on the type of anesthesia: сontrol group – only general anesthesia (GA), Pec group – GA plus pectoralnerve block type II and PVB group – GA plus thoracic paravertebral block. Prevalence, severity and location of persistent pain, quality of life and sensory disturbances assessed after 3 and 6 months after surgery. Results. Throughout three months after surgery 41% women in Pec group, 33% in the PVB group and 7% in GA group didn’t have any pain (p=0,006). Throughout six months after surgery 38% patients in Pec group, 43% in PVB group and 28% in GA group were pain-free (p=0,445). Among those patients who had pain, the rate of patients with moderate pain was higher in GA group, but without statistical significance. No patients had severe pain. The lowest rate of paresthesia by three months after surgery was in Pec group – 28%, in PVB and control groups – 57% and 59% respectively (p=0,026). Six months after surgery 16% of patients had paresthesia in Pec group, 38% in GA group and 53% in PVB group (0,006). The pain location did not differ between groups. Most often the pain appearsin the postoperative scar, less often in the axilla, upper extremity and chest wall. The deterioration of the quality of life after 3 months due to pain was observed in 21% patient in control group, 13% in the PVB group, and 6% in the PB group (p=0.243). And sixmonths after surgery these incidence rates– 10%, 3% and 6% respectively (p=0.553). Conclusions. Compared with thoracic paravertebral block and general anesthesia alone, the pectoral nerve block type II is associated with decreasing of PMPS incidence during first three months and decrease of paresthesias incidence first six months after breast cancer surgery

thoracic paravertebral block, pectoral nerve block, breast surgery, chronic pain

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«Bulletin of problems biology and medicine» Issue 2 (160), 2021 year, 109-115 pages, index UDK 616-089.5-003.83:618.19-089

10.29254/2077-4214-2021-2-160-109-115