Mastektomi Yapılan Hastalarda Kronik Ağrı; Pectoral Sinir Bloğu (PECS I-II) İle Erektör Spina Plan (ESP) Bloğunun Farkının Gözlemlenmesi. Hacettepe Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Ankara, 2024.
Özet
Post-mastectomy chronic pain is defined as chronic breast or chest wall pain that lasts at least 3 months following surgery. Pectoral nerve block (PECS I-II) or erector spinae plane (ESP) block is routinely performed during mastectomy to reduce the risk of pain. However, there is not enough evidence in the literature to show the superiority of these analgesia methods over each other. The aim of our study is to compare the effects of these methods on postoperative pain level and quality of life. For this purpose, adult patients who underwent mastectomy using PECS I-II or ESP in our center were included in the prospective study. The patients were questioned about their DN4 [“Douleur Neuropathique 4” (DN2 in the 3rd month)], NRS (Numerical Rating Scale) and SF-12 (Short Form-12) scales at the 20th minute, 6th hour, 24th hour and 3rd month postoperatively. Analgesia methods were compared in terms of postoperative pain and quality of life scale scores. The incidence of neuropathic pain (DN4 score ≥4) within the first 24 hours postoperatively was comparable between patients treated with PECS I-II and ESP. However, the median NRS score at 20 minutes postoperatively was significantly higher in the PECS I-II group compared to the ESP group (p=0.016). The mean time to first postoperative analgesia was 227±54 minutes for the PECS I-II group and 260±53 minutes for the ESP group (p=0.048). No significant differences were observed between the groups in terms of neuropathic pain frequency, median NRS score, or mean SF-12 scores at the 3-month postoperative follow-up. Additionally, lymph node dissection was identified as a factor associated with pain presence at the 3-month mark (p=0.013). The presence of pain at this time point was also correlated with a lower physical quality of life (p<0.001). In conclusion, while the ESP technique was associated with less pain in the first 20 minutes postoperatively and a delayed requirement for analgesia within the first 24 hours, there was no significant difference between PECS I-II and ESP in terms of pain or quality of life outcomes at the 3-month postoperative period. Lymph node dissection emerged as a significant factor contributing to chronic pain after mastectomy, which in turn was associated with a reduction in patients' physical quality of life.
