Comparison Between PECS BLOCK 2 vs ESP BLOCK in Ocnologic Breast Surgery (ESPECS)

• ClinicalTrials.gov Identifier: NCT05558917
• Recruitment Status: Enrolling by invitation
• First Posted: September 28, 2022
• Last Update Posted: September 28, 2022
• Sponsor: Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo di Alessandria
• Information provided by (Responsible Party): Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo di Alessandria

Study Description

Brief Summary:

The study aims to compare the efficacy of the two operating blocks PECS2 and ESP by measuring postoperative opioid consumption and, secondarily, to compare (between PECS and ESP) postoperative opioid consumption between surgery with/without axillary cavity dissection and with/without implantation of prosthesis or expansion

Condition or disease	Intervention/treatment	Phase
Breast Cancer; Breast Neoplasms; Breast Carcinoma	Procedure: PECS BLOCK 2; Procedure: ESP BLOCK	Not Applicable

Detailed Description:

Breast cancer is the most frequent type of cancer in the female population. Early detection is the most effective tool for improving prognosis, and the surgical approach plays a central role in the treatment of this disease. However, many are the psychophysical implications that patients face: among the main ones is postoperative and chronic pain, a symptom that greatly worsens the quality of life.

In the last decade it has been witnessed an important development of locoregional anesthesia techniques in all surgeries. In breast surgery, particularly mastectomy, the following locoregional anesthesia techniques are referred to as the Gold Standard:

1. PVB (Paravertebral Block)
2. PECS2 BLOCK (or modified PECS). For the same purposes, ESP Block (Erector Spinae Plane Block) has been applied experimentally, which has already shown its effectiveness in breast surgery in several trials.

By comparing postoperative opioid consumption between the two groups of patients, divided into PECS Block and ESP Block, the study aims to identify which anesthesia block is most effective in order to improve the care of patients undergoing mastectomy.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 160 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Supportive Care
• Official Title: Comparison Between PECS BLOCK 2 vs ESP BLOCK in Ocnologic Breast Surgery: Randomized Controlled Trial on Postoperatory Oppioid Consumption
• Actual Study Start Date: September 7, 2022
• Estimated Primary Completion Date: September 7, 2023
• Estimated Study Completion Date: November 7, 2023

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: PECS BLOCK 2; PECS 2 (or modified PECS) is a block that involves the administration of local anesthetic under ultrasound guidance between the great pectoral and small pectoral and between the small pectoral and serratus anterior.	Procedure: PECS BLOCK 2; With the patient supine, the linear probe will be placed in the sagittal plane slightly lateral to the hemiclavicular line ipsilateral to the surgical site. Once both muscle planes of interest have been identified, in-plane needle insertion will proceed in the cranio-caudal direction. The first local anesthetic administration with Ropivacaine 0.5% will be 20ml between small pectoralis and serratus anterior. Coming out with the needle, 10ml of Ropivacaine 0.5% will then be injected between large and small pectoral.
Experimental: ESP BLOCK; ESP block is a block that involves injection of local anesthetic below the elevator muscles of the spine.	Procedure: ESP BLOCK; Positioning yourself behind the patient, lying on her side with the surgical hemilateral on top, you place the linear ultrasound probe in the sagittal plane and find the lateral margin of the transverse process. At this point, the blocking needle is inserted in the caudocranial direction and 25ml of Ropivacaine 0.5% is injected, taking care to visualize the anesthetic spread in the cranial direction.

Outcome Measures

Primary Outcome Measures :

1. Morphine equivalent consumption in the postoperative 24h in simple mastectomies [ Time Frame: Postoperative 24 hours ]
   Morphine-equivalent consumption in the postoperative 24h that patients self-administer between the group of patients undergoing ESP and those undergoing PECS 2 in simple mastectomies.

Secondary Outcome Measures :

1. Morphine-equivalent consumption in the postoperative 24h in mastectomies with axillary cavity emptying [ Time Frame: Postoperative 24 hours ]
   Morphine-equivalent consumption in the postoperative 24h that patients self-administer between the group of patients undergoing ESP and those undergoing PECS 2 in mastectomies with axillary cavity emptying.
2. Morphine-equivalent consumption in the postoperative 24h in mastectomies with prosthesis or expander placement [ Time Frame: Postoperative 24 hours ]
   Consumption of morphine equivalents in the postoperative 24h that patients self-administer between the group of patients undergoing ESP and those undergoing PECS 2 in astecctomies with prosthesis or expander placement.
3. Morphine-equivalent consumption in the postoperative 24h in mastectomies with axillary cavity emptying and implantation of prosthesis or expander [ Time Frame: Postoperative 24 hours ]
   Consumption of morphine equivalents in the postoperative 24h that patients self-administer between the group of patients undergoing ESP and those undergoing PECS 2 in mastectomies with axillary cavity emptying and implantation of prosthesis or expander
4. PONV (Post Operating Nausea and Vomiting) [ Time Frame: Immediately after the surgery and at 2-4-8-12-24 hours after surgery ]
   Number of times the patient experienced nausea or vomiting
5. Complications incidence [ Time Frame: Postoperative 24 hours ]
   Number of times the patient experienced complications such as bleeding or pneumothorax
6. Time from end of surgery to first walk [ Time Frame: Postoperative 72 hours ]
   Time in hours
7. Length of hospitalization [ Time Frame: Up to 7 days ]
   Lenght in days
8. Patient's Likert Scale [ Time Frame: Postoperative 24 hours ]
   Patient satisfaction, from 1 - Strongly disagree to 5 - Strongly agree
9. Surgeon's Likert scale [ Time Frame: Postoperative 24 hours ]
   Surgeon satisfaction, from 1 - Strongly disagree to 5 - Strongly agree

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Patients undergoing mastectomy exclusively for breast cancer
• Presence of written informed consent to the trial

Exclusion Criteria:

• Bilateral breast surgery
• Previous drug use
• Chronic opioid and minor opioid therapy
• BMI >40
• Allergy or contraindications to taking Paracetamol and Toradol
• Inability to use PCA (Patient Controlled Analgesia)
• Intraoperative opioid administration
• Patients with neuropathy

Contacts and Locations

Locations

Italy

Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo

Alessandria, Piedmont, Italy, 15121

Sponsors and Collaborators

Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo di Alessandria

Investigators

• Principal Investigator: Mirco Leo, Physician; Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo

More Information

• Responsible Party: Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo di Alessandria
• ClinicalTrials.gov Identifier: NCT05558917
• Other Study ID Numbers: ASO.RianGen.22.02
• First Posted: September 28, 2022
• Last Update Posted: September 28, 2022
• Last Verified: August 2022

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo di Alessandria:

PECS2; ESP BLOCK; Breast Anesthesia; Mastectomy; Breast Cancer

Additional relevant MeSH terms:

Breast Neoplasms; Neoplasms by Site; Neoplasms; Breast Diseases; Skin Diseases