Questions · Pectoral Nerve Blocks
10 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
A meta-analysis of 13 randomised trials including 815 patients compared the PECS II block against systemic analgesia alone and against a thoracic paravertebral block for breast cancer surgery. State what it found for each of the two comparisons, and say how you should therefore describe the block to a surgeon who already offers paravertebral blocks.
Answer: Against systemic analgesia alone the PECS II block reduced 24-hour opioid consumption by about 13.6 mg oral morphine equivalents (95% CI -21.2 to -6.1) and lowered acute pain scores at every interval in the first 24 hours. Against a thoracic paravertebral block it was no better: opioid consumption differed by 8.7 mg oral morphine equivalents with a confidence interval crossing zero (-18.2 to 0.7, p = 0.07), and pain scores were similar after the first measurement. So the honest description is that PECS II clearly beats no block and is a comparable alternative to a paravertebral block, not an improvement on one.
Two comparisons in one paper answer two different questions. "Better than nothing" is not "better than the standard", and the confidence interval crossing zero is what separates them here.
Source claim: Pooling 13 randomised trials with 815 patients, the PECS II block reduced 24-hour postoperative opioid consumption by 13.64 mg oral morphine equivalents (95% CI -21.22 to -6.05) and reduced acute postoperative pain at all intervals in the first 24 hours compared with systemic analgesia alone, but gave similar opioid consumption (-8.73 mg oral morphine equivalents, 95% CI -18.16 to 0.69, p = 0.07) and similar postoperative pain scores after the first measurement compared with a thoracic paravertebral block.
Versyck B et al., Analgesic efficacy of the Pecs II block: a systematic review and meta-analysis, Anaesthesia 2019
recall · CA-2 · phrased by llm
A randomised, double-blind, placebo-controlled trial in 128 patients tested the PECS I block against saline for breast cancer surgery, with a multimodal analgesic regimen and surgeon-administered local infiltration in every patient. What was the result for the primary outcome, and what does the design of that trial tell you about when a PECS I is worth doing?
Answer: It was negative. Pain score in recovery was a median of 3.0 in both the bupivacaine and the saline groups (p = 0.55), and cumulative morphine consumption up to 24 hours did not differ. Only in the subgroup having major surgery — mastectomy or tumourectomy with axillary clearance, 29 patients — was there a difference, and the authors describe it as statistically significant although not clinically significant. The design is the point: against a background of multimodal analgesia plus surgical infiltration, a block that covers only the pectoral nerves has very little left to add. Note what the authors themselves conclude from the subgroup — not that PECS I is worthwhile for extensive operations, but that its role in extended breast surgery may warrant further investigation.
In this trial the comparator was not nothing: every patient, in both arms, also received multimodal analgesia and surgeon-administered local infiltration. Read what else the patient is already getting before concluding from a negative trial that the block does not work.
Source claim: In 128 patients randomised to a PECS I block with bupivacaine or saline for breast cancer surgery, all receiving multimodal analgesia and surgeon-administered local infiltration, recovery-room pain scores were a median of 3.0 in both groups (p = 0.55) and cumulative morphine consumption up to 24 hours did not differ, so PECS I was not better than placebo; in the 29 patients undergoing major surgery (mastectomy or tumourectomy with axillary clearance) the pain score difference was statistically significant although not clinically significant (3.0 vs 4.0, p = 0.04) and recovery-room morphine was lower (1.5 mg vs 6.0 mg, p = 0.016), and the authors conclude that the role of PECS I in extended (major) breast surgery may warrant further investigation.
Cros J et al., Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial, Reg Anesth Pain Med 2018
recall · CA-2 · phrased by llm
This randomised trial found that for patients undergoing uniportal thoracoscopic surgery, surgical intercostal nerve blocks with ___ ml of 0.5% ropivacaine significantly reduce 12-h morphine consumption and systemic local anesthetic absorption compared to ultrasound-guided erector spinae plane blocks.
Answer: 30
This randomised trial found that for patients undergoing uniportal thoracoscopic surgery, surgical intercostal nerve blocks with 30 ml of 0.5% ropivacaine significantly reduce 12-h morphine consumption and systemic local anesthetic absorption compared to ultrasound-guided erector spinae plane blocks.
Erector Spinae Plane Block versus Intercostal Nerve Blocks in Uniportal Videoscopic-assisted Thoracic Surgery: A Multicenter, Double-blind, Prospective Randomized Placebo-controlled Trial · PMID 40537064
recall · CA-2 · phrased by derived
This meta-analysis found that PECS I or II blocks for breast cancer surgery decreased intraoperative opioid use by a mean difference of 5.28 and extended time to first rescue analgesia by ___ hours versus placebo.
Answer: 4.95
This meta-analysis found that PECS I or II blocks for breast cancer surgery decreased intraoperative opioid use by a mean difference of 5.28 and extended time to first rescue analgesia by 4.95 hours versus placebo.
Pectoral Nerve Blocks for Breast Cancer Surgery: A Systematic Review and Meta-Analysis · PMID 41632458
recall · CA-2 · phrased by derived
This randomized trial found that administering i.v. esketamine at ___ mg/kg alongside either erector spinae or intercostal nerve blocks improves 24-hour quality of recovery scores in adults undergoing thoracoscopic lung resection.
Answer: 0.3
This randomized trial found that administering i.v. esketamine at 0.3 mg/kg alongside either erector spinae or intercostal nerve blocks improves 24-hour quality of recovery scores in adults undergoing thoracoscopic lung resection.
Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: a randomized controlled factorial trial · PMID 39172717
recall · CA-2 · phrased by derived
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.