The pectoralis-II myofascial block for breast cancer surgery is a safe and effective alternative to the paravertebral block, demonstrating non-inferiority for 24 hour pain and analgesia need.

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• Nasir Hussain, Richard Brull, McCartney Colin J L CJL, Patrick Wong, Nicolas Kumar, Michael Essandoh, Tamara Sawyer, Timothy Sullivan, and Faraj W Abdallah.
• From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio (N.H., N.K., M.E.) Department of Anesthesiology, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada (R.B.) Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (C.J.L.M., P.W., T. Sullivan, F.W.A.) The Ohio State University College of Medicine, Columbus, Ohio (N.K.) Central Michigan University College of Medicine, Mt. Pleasant, Michigan (T. Sawyer) Department of Anesthesia, and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (F.W.A.).
• Anesthesiology. 2019 Sep 1; 131 (3): 630-648.

BackgroundThoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery.MethodsDatabases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling.ResultsFourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of -30.5 mg [-42.2, -18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by -4.7cm · h [-5.1, -4.2] or -1.2cm [-1.3, -1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes.ConclusionsWe found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.

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