U/S Guided Transversus Thoracic and Pectoral Nerve Block Versus Pectoral Nerve Block in MRM

Summary

Interfascial blocks score over regional anesthetic techniques such as Transversus Thoracic Plane Block and Pectoral Nerves (PECS) Block as they have no risk of sympathetic blockade, intrathecal or epidural spread, which may lead to hemodynamic instability and prolonged hospital stay. The transversus thoracic muscle plane block (TTP) block is a newly developed regional anesthesia technique which provides analgesia to the anterior chest wall. First described by Ueshima et al. in 2015, the TTP block is a single-shot nerve block that deposits local anesthetic in the transversus thoracic muscle plane between the internal intercostal and transversus thoracic muscles. TTP block targets the anterior branches of the intercostal nerves (T2-6).

Pectoral plane blocks are recently described . PECS block involves deposition of local anesthetic drug between muscle planes. PECS I block, between Pectoralis Major and Minor at third rib level, and PECS II block, the drug is deposited between Pectoralis minor and Serratus anterior muscle.

The pectoral nerves (PECS) block provides analgesia of the lateral mammary region, the intercostobrachial and lateral cutaneous branches of the intercostal nerves (T2-T6), the medial cutaneous nerve of the arm and forearm, and the long thoracic and thoracodorsal nerves. The modified PECS block produces excellent analgesia and can be used to provide balanced anesthesia.

Conditions

• Breast Cancer
• Analgesia

Interventions

PROCEDURE

Transeversus Thoracic Plane Block (TTPB) and Pectoral Nerves (PECS) Block

The TTP block will be performed in a supine position before general anesthesia. First, a high linear probe of the ultrasound system will be attached at sagittal plane to the sternum and counted from T2 near the clavicle to T5. Then the linear probe will be rotated by 90° and attached between the forth and the fifth costal cartilages connecting at the sternum near nipple. Then, the transversus thoracic muscle and the internal intercostal muscle will be identified. A total of 15 mL of 0.25% bupivacaine will be injected into the interfascial plane, between the transversus thoracic muscle and the internal intercostal muscle between the fourth and fifth costal cartilages connecting at the sternum. Pleural downward displacement will be used as an ultrasound endpoint.

PROCEDURE

Pectoral Nerves (PECS) Block

Patients positioned supine with the ipsilateral arm abducted and externally rotated. The infra-clavicular and axillary regions will be cleaned with chlorhexidine. The skin point of and once the structures are identified with ultrasound, the probe will be positioned under the lateral third of the clavicle. After locating the subclavian artery, the axillary artery and the axillary vein we will move the probe distally towards the axilla, until the pectorals major muscle is identified. We will start counting the ribs, from 1st rib under the axillary artery and maintaining the pectorals major. Serratus anterior muscle cover 2nd, 3rd, 4th rib, this point being the entrance into the anterior axillary line we will use atraumatic needle with extension line and electrode for nerve stimulator (Stimuplex D). We will inject 10ml of 0.25% bupivacaine between the pectorals muscles first, then inject 20ml of 0.25% bupivacaine.

Sponsors & Collaborators

• Ahmed Mohamed Soliman

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

20 Years

Max Age

60 Years

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2022-07-02

Primary Completion

2023-08-01

Completion

2023-10-01

Countries

• Egypt

Study Locations