Ultrasound-guided Interfascial Plane Blocks for Non-anesthesiologists in Breast Cancer Surgery: Functional Outcomes and Benefits.
AIM
Acute post-operative pain following modified radical mastectomy (MRM) in patients with breast cancer is challenging for anesthesiologists. This study aimed to prospectively compare the quality outcome of interfascial plane blocks performed with ultrasound guidance, and evaluate the consequences of sharing tasks with the breast surgeon.


PATIENTS AND METHODS
The study involved 255 patients scheduled for unilateral MRM, who were divided into two groups: Pecs group: General anesthesia plus ultrasound-guided modified pectoral nerves blocks type I and II, including serratus and parasternal infiltration according to surgical requirements; and Control group: general anesthesia only. Quality was evaluated based on perioperative opioid consumption, reported pain intensity, rescue analgesic requirement, side-effects and length of hospital stay. Moreover, a breast surgeon with expertise in ultrasound-guided breast biopsy was trained to perform the blocks. The patient benefits from regional anesthesia delivered by a non-anesthesiologist were assessed.


RESULTS
Significant reductions were noted in all of the following: Intraoperative opioid consumption (p<0.001), Numerating Rating Scale pain scores taken 0 and 24 h after surgery (p<0.001), post-operative analgesic administration (p<0.001), nausea and vomiting at 0, 6, and 12-h intervals (p<0.05), and hospital stay (p<0.001) were observed in the Pecs group compared with the control group. Furthermore, data obtained from patients receiving the block from the surgeon showed comparable benefits with no complications.


CONCLUSION
Interfascial plane blocks may be an important alternative protocol in MRM, enhancing patient safety and cost benefits. Improvements in cross-disciplinary expertise through flexibility in the training of professionals with other backgrounds may provide effective analgesia and favorable outcomes.
['Grasso|Antonella|A|', 'Orsaria|Paolo|P|', 'Costa|Fabio|F|', "D'Avino|Valentina|V|", 'Caredda|Emanuele|E|', 'Hazboun|Anton|A|', 'Carino|Rita|R|', 'Pascarella|Giuseppe|G|', 'Altomare|Michele|M|', 'Buonomo|Oreste Claudio|OC|', 'Agrò|Felice Eugenio|FE|', 'Altomare|Vittorio|V|']
D000328:Adult D000368:Aged D000768:Anesthesia, General D000072080:Anesthesiologists D001940:Breast D001943:Breast Neoplasms D005260:Female D006801:Humans D015411:Mastectomy, Modified Radical D008875:Middle Aged D009407:Nerve Block D010147:Pain Measurement D010149:Pain, Postoperative D011446:Prospective Studies D013900:Thoracic Nerves D018084:Ultrasonography, Interventional
modified radical mastectomy regional anesthesia Pecs block breast surgery nonphysician anesthesia provider postoperative pain