Análise do controle álgico de pacientes submetidos ao bloqueio peitoral (PEC) nas mastectomias com linfadenectomias

Abstract

Introduction: Breast cancer is the most common malignant neoplasm in women worldwide. Its treatment is classified as systemic, when use chemotherapy, hormone therapy and/or molecular and local; surgical, radical or conservative; and radiotherapy. Surgery has been the traditional treatment for breast cancer, even after previous chemotherapy, and in most cases, mastectomy is performed with evaluation of axillary lymph nodes. Patients undergoing mastectomies with axillary dissection have a lot of pain in postoperative. Therefore, we look for study techniques of regional block that can minimize this effect, like pectoral block (PEC). Objective: To evaluate the efficacy of isolated PEC anesthetic block to control pain When compared to the use of intravenous analgesics in the postoperative period of radical mastectomy, in addition to evaluating the average consumption of opioids in 24 hours. Methodology: Clinical, randomized, controlled trial with 82 patients with breast cancer who underwent mastectomy with an axillary approach. Two randomized groups were used: a group without PEC (control), exclusive general anesthesia, and a group with PEC, receives general anesthesia and PEC block with Levobupivacaine/Ropivacaine. Prescription of Novalgin, Tramadol and morphine was offered in post-surgery just if needed. 24 hours after the operation, a questionnaire with the EVA scale was applied. Shapiro-Wilk (data normality), Mann-Whitney (comparison between groups) and Chi-square (comparison of proportions) tests were used. Data was analyzed in R version 4.0.0 environment. Results: Analyzing the variables sex, comorbidities, histological type of tumor, clinical staging and molecular classification, there were a statistical similarity between the groups with and without PEC. In the group with PEC, 50% of patients were pain free 24 hours after surgery, whereas in the control group, the correspondence was 42.86%. The majority who presented pain classified it as mild pain (EVA from 1 to 3), corresponding to 42.50% in the group with PEC and 40.48% in the control group (p = 0.28). There was opioid consumption in 17.50% of the group with PEC, while in the control group consumption was 21.43%, a difference that proved to be non-significant (p=0.65). There was a low rate of complications as PONV in both groups. Conclusion: The present study demonstrated that there are no benefits with the performance of the pectoral block technique (PEC) in patients undergoing mastectomy for the treatment of breast cancer.