Paravertebral versus Pectoralis-II (Interpectoral and Pectoserratus) Nerve Blocks for Postoperative Analgesia after Nonmastectomy Breast Surgery: A Randomized, Controlled, Observer-masked Noninferiority Trial
Authors' conclusion
After nonmastectomy breast surgery, two-level paravertebral blocks provided superior analgesia and opioid sparing compared with pectoralis-II blocks.
Study context
- Population
- Patients undergoing uni- or bilateral nonmastectomy breast surgery anticipated to have at least moderate postoperative pain79% of target 150
- Participants
- 119 patients
- Comparison
- Pectoralis-II vs paravertebral block
- Pectoralis-IIn = 60
- Paravertebraln = 59reference
- Primary endpoint
- Dual primary: analgesia (NRS) and cumulative opioid consumption within the operating and recovery rooms combined
Methodological detailsobserver-masked, noninferiority, dual primary outcomes, ended prematurely, Ended prematurely at 119 of 150 target due to (masked) surgeon preference
- Observer-masked
- Noninferiority
- Dual primary outcomes
- Ended prematurely
- Ended prematurely at 119 of 150 target due to (masked) surgeon preference
Primary result
As reported in the abstract
Pain scores (NRS) in recovery room; IV morphine equivalents
Pectoralis-II
3.3
median · IQR 2.3–4.8
Paravertebral
1.3
median · IQR 0–3.6
Pectoralis-II
17.5
IQR 12.5–21.9 · mg
Paravertebral
10.0
IQR 10–20 · mg
Pectoralis-II vs Paravertebral: 95% CI 0.5–2.6; P < 0.001 · Pectoralis-II vs Paravertebral: 95% CI 0.1–7.5; P = 0.004
Safety
Events
| Outcome | Pectoralis-II | Paravertebral |
|---|---|---|
| Block-related adverse events | 0 | 0 |
Original publication
Paravertebral versus Pectoralis-II (Interpectoral and Pectoserratus) Nerve Blocks for Postoperative Analgesia after Nonmastectomy Breast Surgery: A Randomized, Controlled, Observer-masked Noninferiority Trial. Anesthesiology. Published 7 November 2024. doi:10.
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