Ultrasound-guided modified intercostal nerve block improves analgesia after radical mastectomy: A randomized controlled trial

BACKGROUND: Radical mastectomy often causes acute and chronic pain. One aimed to explore whether unilateral, ultrasound-guided, single-injection modified intercostal nerve block (MINB) could improve postoperative analgesia compared with no-MINB (Control group) in patients undergoing radical mastectomy. METHODS: Sixty-five patients were randomly assigned to receive no-MINB (Control group) or MINB (MINB group) with 0.33 % ropivacaine (30 ml). The primary outcome was Visual Analogue Scale (VAS) scores at rest 6 h postoperatively. Secondary outcomes included VAS scores at rest and during movement at 0 h, 12h, 24h, 48h, and 90 days postoperatively; use of intraoperative opioids; postoperative rescue analgesia; time of first ambulation; complications; and score of China version of the Quality of recovery-15 (QoR-15) questionnaire (0 = extremely poor QoR; 150 = excellent QoR) at 24 h after surgery. RESULTS: The MINB group showed lower resting VAS (resting) pain score at 6 h postoperatively (median [interquartile], 1 (0-2), vs 2 (2-3), 95 % CI difference in medians 1-2; P < 0.001), and significantly lower scores at resting and during movement at 0-24 h postoperatively. The MINB group showed lower intraoperative opioid use, a better quality of recovery on the QoR-15 scale, and more patients needed rescue analgesia in control group compared to those in MINB group. None of the MINB subjects showed MINB-related complications. CONCLUSION: Preoperative ultrasound-guided MINB markedly improved analgesia and concurrently reduced rescue analgesia demands and better recovery in patients undergoing radical mastectomy.