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Pectoral Nerve (PECs) block for postoperative analgesia-a systematic review and meta-analysis with trial sequential analysis.

ABSTRACT: BACKGROUND AND OBJECTIVE:Pectoral Nerve (PECs) block is a fascial plane block first described by Blanco et al. for postoperative analgesia in breast surgery. The procedure is now widely used, and several small clinical trials have been published and reported favorably on the analgesic efficacy of PECs block. In this systematic review and meta-analysis, we will summarize the current evidence on the efficacy of PECs block. METHODS:We identified and analyzed 19 randomized control trials from PubMed, Central, EMBASE, CINAHL, Web of Science citation index, US clinical trials register and Google Scholar. The primary outcome was 24-hour opioid requirement, and secondary outcomes included pain scores, postoperative nausea and vomiting and other complications. RESULTS:Compared to systemic analgesia, PECs block was associated with reduced 24 hours opioid requirement [mean difference (MD) = -10.66 mg], lower pain score [9-12 hours postoperatively: MD = -1.18; 24 hours postoperatively: MD = -0.79] and less frequent PONV [risk ratio (RR) = 0.37, numbers needed to treat (NNT) = 5]. While the failure rate of PECs block was not well defined, several studies reported significant intraoperative opioid requirement despite PECs block. Lastly, trial sequential analysis indicated that no more clinical trials are needed to demonstrate the opioid sparing effect of PECs block. CONCLUSION:When compared to general anesthesia with systemic opioids, PECs block was associated with significantly better perioperative pain control. There are currently insufficient data on the complication and failure rate of PECs block in clinical practice.

SUBMITTER: Jin Z

PROVIDER: S-EPMC7076325 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Pectoral Nerve (PECs) block for postoperative analgesia-a systematic review and meta-analysis with trial sequential analysis.

Jin Zhaosheng Z Li Ru R Gan Tong J TJ He Yaohua Y Lin Jun J

International journal of physiology, pathophysiology and pharmacology 20200225 1

<h4>Background and objective</h4>Pectoral Nerve (PECs) block is a fascial plane block first described by Blanco et al. for postoperative analgesia in breast surgery. The procedure is now widely used, and several small clinical trials have been published and reported favorably on the analgesic efficacy of PECs block. In this systematic review and meta-analysis, we will summarize the current evidence on the efficacy of PECs block.<h4>Methods</h4>We identified and analyzed 19 randomized control tri ...[more]

PMID: 32211121

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Project description:BackgroundAs an optional regional anesthesia approach, pericapsular nerve group (PENG) block has been successfully utilized to manage pain for hip surgeries without affecting motor function. The present meta-analysis aimed to verify the efficacy of PENG block for postoperative analgesia in patients undergoing hip surgery.MethodsA total of 497 academic articles were identified after a systematic search in the databases of PubMed, Embase, Web of Science, and Cochrane Library up to 25 August 2022. The primary outcome was postoperative 24-h morphine consumption. Secondary outcomes included the time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and incidence of postoperative nausea and vomiting (PONV). We calculated mean differences (MDs) with 95% confidence intervals (CIs) for postoperative 24-h morphine consumption, time of the first request for rescue analgesia, static and dynamic pain scores 6 and 24 h after surgery, and odds ratios (ORs) with 95% CIs for incidence of PONV. The chi-square test was used for heterogeneity analysis, and heterogeneity was assessed by I 2. Statistical analysis was performed using Review Manager 5.4.ResultsNumerous electronic databases were searched, and finally, nine studies were identified. There was no significant difference in morphine consumption during the postoperative 24 h [MD: -2.57, 95% CI: (-5.42, 0.27), P = 0.08] and the time of the first request for rescue analgesia [MD: 1.79, 95% CI: (-1.06, 4.64), P = 0.22] between the PENG block and control groups. PENG block did not reveal a significant difference in 6 h [MD: -0.17, 95% CI: (-0.92, 0.57), P = 0.65] [MD: -0.69, 95% CI: (-1.58, 0.21), P = 0.13] and 24 h [MD: -0.25, 95% CI: (-1.54, 1.05), P = 0.71], [MD: 0.05, 95% CI: (-0.84, 0.93), P = 0.91] static and dynamic pain scores compared with other nerve block methods. Moreover, the two groups have a similar risk of PONV (OR: 1.29, 95% CI = 0.53-3.10, P = 0.57).ConclusionThis review shows that PENG block can act as an alternative multimodal analgesia for hip surgery, and compared with the other kinds of nerve block, there was no significant difference in the postoperative analgesic effect of PENG block.Systematic review registrationSupplementary Datasheet 1, identifier: CRD 42022356496.

Dataset Information

Pectoral Nerve (PECs) block for postoperative analgesia-a systematic review and meta-analysis with trial sequential analysis.

Publications

Pectoral Nerve (PECs) block for postoperative analgesia-a systematic review and meta-analysis with trial sequential analysis.

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