CAP. 5 FUSCO.pdf

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Interpectoral plane block (IPP) and Pectoserratus plane block (PSP) (PECS 1 and PECS 2 blocks) Pierfrancesco Fusco, Stefano Di Carlo, Emiliano Petrucci, Giuseppe Sepolvere, Rafa Blanco

Breast cancers are one of the most frequent oncological pathologies in women, representing 31% of all the cases of neoplasia in the female population on an annual basis. Breast surgery, frequently extended to the axillary region, is currently one of the most common procedures performed in hospitals. These surgical interventions cause the onset of an acute postoperative pain of moderate to severe intensity which, if not properly treated, like other surgical procedures, can increase perioperative morbidity and hospitalization times/costs, as well as cause the development of a chronic pain (postmastectomy pain syndrome) in 25-60% of the cases, with the significant impairment of the quality of life. To date, the control of the post-operative pain in breast and axillary surgery is frequently unsatisfactory. Generally, the treatment of postoperative pain in breast surgery is based on a multimodal approach that involves the use of analgesic drugs via systemic administration, with opioids representing the most important ones. However, these drugs are characterized by the onset of related and dose-dependent side effects such as respiratory depression, nausea, vomiting, itching, sedation, delayed canalization, hypotension, and urinary retention, in addition to immunosuppressive and pro-metastatic effects. In oncological patients, the acute postoperative pain can cause a change in the immunological response, while the association of an opioid treatment, with further depression of the immune system, can cause neoplastic proliferation and

tumor/metastatic relapses, in addition to infections. However, scientific evidence shows how breast surgery, female sex, young age, general anesthesia, volatile anesthetics, and the use of systemic opioids are risk factors for the onset of postoperative nausea and vomiting (PONV). The related literature highlights the importance of adopting locoregional anesthesia/analgesia (LRA) techniques to achieve better antalgic control and avoid the use of opioids, particularly in patients with risk factors for PONV. Nowadays, the concept of “preventive analgesia” is widely acknowledged: in other words, the execution of LRA techniques before surgery can allow to achieve an excellent control of the acute postoperative pain and a rapid recovery of the normal physiological functions, thus preventing at the same time central sensitization phenomena underlying the development of a persistent postoperative pain. Currently, thoracic epidural analgesia and paravertebral block are the main LRA techniques for postoperative analgesia in breast surgery. However, although these techniques allow to achieve excellent pain control, they are not always easy to perform, and frequently are even contraindicated, due to the possible onset of systemic side effects or procedural complications. The recent introduction of new ultrasound-guided blocks of the chest wall, described by Raphael Blanco, can open new horizons in the management of postoperative pain in breast surgery. The new generation of superficial and thus less invasive interfascial nerve blocks include the PECS 1 block, the PECS 2 block, and

IPP and PSP (PECS 1 and PECS 2 blocks)

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