Comparison of Pectoral Nerve and Paravertebral Blocks for Postoperative Pain Management in Breast Surgery: A Multicentre Randomised Double-Blind Trial

Abstract

Purpose: Pectoral nerve (PECS) blocks have gained popularity for pain management in breast cancer surgery because of their ease of use and lower risk profile. However, their efficacy compared with that of paravertebral block (PVB) remains uncertain. This study aimed to evaluate the non-inferiority of the PECS block to PVB for postoperative analgesia. Methods: This prospective, randomized, double-blind trial included adult patients (American Society of Anesthesiologists status 1-3) scheduled for elective breast cancer surgery. The patients were randomized to receive either a PECS block or PVB. The primary outcome was block success, defined as a Visual Analogue Scale pain score of < 30 at 30 minutes, 6 hours, and 24 hours postoperatively. The secondary outcomes included opioid consumption, block performance time, functional recovery, and patient satisfaction. Results: Of the 42 patients, 23 received a PECS block and 19 received PVB. Successful blocks were achieved in 69.6%, 81.8%, and 77.3% of patients with PECS blocks and 63.2%, 68.4%, and 88.9% of patients with PVB at 30 minutes, 6 hours, and 24 hours, respectively. The non-inferiority of PECS was significant at 30 minutes and 6 hours but inconclusive at 24 hours. The PECS blocks were performed faster (7 vs. 14 minutes, p < 0.001). Opioid consumption, global satisfaction, and functional recovery were comparable with no reported complications. Conclusion: Our study shows that the PECS block is non-inferior to the PVB in managing postoperative pain after breast surgery, offering advantages such as reduced administration time and a favorable safety profile. These findings support the integration of the PECS block into pain management strategies for breast cancer surgery.