Audit of Pectoralis (PECS) and Serratus Anterior Plane (SAP) blocks for breast surgery

Abstract

Introduction The principal objective of the audit is to -"Improve the quality of care delivered to the patient by minimising the opioid consumption intra and postop and to reduce the complication from opioids." Materials and methods (NA for case report) Formal approval of Derby Hopitals NHS Trust Clinical Governance Team ( equivalent to IRB ) acquired and medical records depatment were contacted for data collection. Retrospective data collection of patients undergoing "minor" breast surgery, between April 2015 - January 2016, in Derby Teaching Hospitals NHS Trust. Procedures excluded: - Reconstruction - Bilateral surgery - Free Flaps Data collected: - Procedure type - PECS block (Y/N) - SAP block (Y/N) - Intraoperative analgesia - Recovery pain score - Recovery opioid consumption - Recovery Nausea and vomiting Results/Case report Conclusions:- Out of 67 patients, 16 had blocks 49 of those with no block, received intra-op opiods +/- adjuvant IV analgesics In recovery, 1 in 16 with PECs required rescue analgesia (6.25%); opposed to 6 in 51 without PECs (11.76%). PONV rates were higher in patients without PECs. Surgery associated with stress response, which has metabolic neuroendocrine haematological and inflammatory /immunological response (cytokine stress responses, suppressed cell-mediated immunity) These are the major factors for peri-op immune suppression and provide a milieu for possible tumor cell proliferation leading to metastases. PECS and SAP Blocks are - Depositing Local Anaesthetic between Thoracic muscles "Myofascial block", similar to Transversus Abdominal Plane (TAP) block easy to do with the advent of USG, increasing accuracy Ability of RA to improve long term outcome after cancer surgery can be attributed to at least 3 different mechanismsattenuates the immunosuppressive effect of surgery decreases the opioid requirement RA + GA more balanced anaesthesia.