Jagasia Puja, Battistini Andrea, Kienzel Stephan, Jordan Sumanas, Ellis Marco
Division of Plastic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA.
Department of Anesthesiology, Northwestern Memorial Hospital, Chicago, IL, USA.
JPRAS Open. 2025 Jul 4;45:379-385. doi: 10.1016/j.jpra.2025.06.023. eCollection 2025 Sep.
Pectoral nerve blocks I and II (PECS I and II) can be given preoperatively under ultrasound guidance by an anesthesiologist or intraoperatively by a surgeon for postoperative pain control. A comparison of analgesia provided by preoperative versus intraoperative PECS blocks could help surgeons decide which method is most effective while optimizing resources.
A retrospective review of patients receiving gender-affirming mastectomies at a single institution was conducted from 2018 to 2024. PECS I/II blocks were delivered intraoperatively before August 2023 and preoperatively thereafter. Twenty mL total of 0.25 % bupivacaine with epinephrine was used for PECSI+II blocks. Analgesic effect was measured with opioid consumption (MME) and patient-reported pain score in the PACU. The need for additional opioid medications after discharge was also evaluated.
A total of 438 subjects were included, with 84.5 % (370/438) in the intraoperative block group and the remaining 15.5 % (68/438) in the preoperative block group. Opioid consumption did not differ between the two groups (intraoperative: 13.1 ± 6.91 MME vs. preoperative: 12.7 ± 5.32 MME, = 0.58). Patient-reported pain scores in the PACU also did not differ between the two groups (intraoperative: 3.89 ± 3.26 vs. preoperative: 2.84 ± 2.38, = 0.54). There was no significant difference in the percentage of patients requiring additional postoperative opioid prescriptions after discharge (preoperative: 4.4 % (3/68), intraoperative: 7.0 % (26/370), = 0.17).
Intraoperative PECS I/II blocks should be utilized over preoperative, ultrasound-guided PECS I/II blocks in the setting of gender-affirming mastectomy to provide effective analgesia while optimizing resource utilization and minimizing costs.
胸肌神经阻滞I和II（PECS I和II）可在术前由麻醉医生在超声引导下进行，或在术中由外科医生进行，以控制术后疼痛。比较术前与术中PECS阻滞提供的镇痛效果有助于外科医生在优化资源的同时决定哪种方法最有效。
对2018年至2024年在单一机构接受性别确认乳房切除术的患者进行回顾性研究。2023年8月之前在术中进行PECS I/II阻滞，之后在术前进行。PECS I+II阻滞共使用20毫升含肾上腺素的0.25%布比卡因。通过阿片类药物消耗量（MME）和患者报告的麻醉后恢复室（PACU）疼痛评分来衡量镇痛效果。还评估了出院后需要额外使用阿片类药物的情况。
共纳入438名受试者，术中阻滞组占84.5%（370/438），术前阻滞组占其余15.5%（68/438）。两组之间的阿片类药物消耗量无差异（术中：13.1±6.91 MME vs.术前：12.7±5.32 MME，P = 0.58）。两组患者在PACU报告的疼痛评分也无差异（术中：3.89±3.26 vs.术前：2.84±2.38，P = 0.54）。出院后需要额外术后阿片类药物处方的患者百分比无显著差异（术前：4.4%（3/68），术中：7.0%（26/370），P = 0.17）。
在性别确认乳房切除术的情况下，应采用术中PECS I/II阻滞而非术前超声引导的PECS I/II阻滞，以提供有效的镇痛效果，同时优化资源利用并降低成本。
