Remifentanil-Sparing Effect of Pectoral Nerve Block Type II in Breast Surgery under Surgical Pleth Index-Guided Analgesia during Total Intravenous Anesthesia

Journal of Clinical Medicine
Jung Ju ChoiHyun Jeong Kwak

Abstract

The pectoral nerve block type II (Pecs II block) can provide adequate perioperative analgesia in breast surgery. The surgical pleth index (SPI) is used to monitor the nociception balance using pulse oximetry. We investigated the remifentanil-sparing effect of Pecs II block under SPI guided analgesia during total intravenous anesthesia (TIVA). Thirty-nine patients undergoing breast surgery under remifentanil-propofol anesthesia were randomly assigned to the intervention (Pecs group, n = 20) or control group (n = 19). Remifentanil and propofol concentrations were adjusted to maintain an SPI of 20-50 and a bispectral index of 40-60, respectively. The Pecs group received an ultrasound-guided Pecs II block preoperatively using 30 mL of 0.5% ropivacaine. Total infused remifentanil during the surgery was significantly less in the Pecs group than in the control group (6.8 ± 2.2 μg/kg/h vs. 10.1 ± 3.7 μg/kg/h, p = 0.001). Pain scores on arrival at the postanesthetic care unit (PACU) (3 (2-5) vs. 5 (4-7)) and the rescue analgesic requirement in the PACU (9 vs. 2) was significantly lower in the Pecs group than in the control group. In conclusion, Pecs II block was able to reduce the intraoperative remifentanil consumption by approximately...Continue Reading

References

Jul 26, 2002·Acta Anaesthesiologica Scandinavica·H StormJ C Raeder
Nov 12, 2009·JAMA : the Journal of the American Medical Association·Rune GärtnerHenrik Kehlet
Nov 8, 2011·British Journal of Anaesthesia·H Freise, H K Van Aken
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Jun 5, 2018·Pain Research & Management : the Journal of the Canadian Pain Society = Journal De La Société Canadienne Pour Le Traitement De La Douleur·Doo-Hwan KimKyu Taek Choi

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Citations

Jun 22, 2020·The Breast Journal·Alessandro FancelluAlberto Porcu
Jan 12, 2021·Plastic and Reconstructive Surgery. Global Open·Hassan ElHawaryJeffrey E Janis
Jun 20, 2021·Regional Anesthesia and Pain Medicine·David H KimStavros G Memtsoudis

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