Comparing analgesic efficacy of different block modalities after breast cancer surgery

OpenAlex · İngilizce

We appreciate Wang et al.1 for their attention and comments on our recently published article.2 We provide the following responses to their comments. The first comment was regarding the sample size calculation of the study for additional analgesic drugs. We thank them for drawing attention to this point. Since a study on comparing these blocks in breast cancer surgery and using meperidine as an additional analgesic was not found, the parenteral morphine dose in Kulhari's study3 was used in this study. We agree that the concerns of Wang et al. sample size are justified since meperidine consumption in the first 24 h was not included in the results. However, in our study, there was no significant difference in meperidine consumption in the first 24 h postoperatively for both groups (in Group PECS [pectoral nerve], 40.00 ± 33.16 mg; in Group TPV [thoracic paravertebral], 50.00 ± 28.28 mg; p = 0.72). The fact that this value was not included in the results was overlooked. As is known, there is an equivalence calculation for opioids such as morphine and meperidine and they can be easily converted to each other in such calculations. In both studies,2, 3 the aim was to investigate whether there was a difference in the consumption of opioids between the groups. In addition to the fact that the patients were administered nonsteroidal anti-inflammatory drugs, the difference in opioid consumption of 20% instead of 30% was considered clinically significant. We took these into account when calculating the sample size in our study. Therefore, we think that our study had sufficient power. Second, Wang et al. argued that the assessment of pain with movement or at resting state was not stated in our study. We assessed pain in a resting position and recorded visual analog scale (VAS) scores. We discussed this in describing the limitations of the study, where we stated that the contribution of upper extremity movements to pain on the surgical side (dynamic VAS) has not been studied. Third, we did not assess shoulder pain because we performed PECS 1 block. It is known that, with this block, the long thoracic and thoracodorsal nerves are not completely4 blocked and consequently PECS 2 block5 was devised. With the PECS 2 block, the long thoracic nerve, two to three thoracic intercostal nerves, and the lateral and medial pectoral nerves are anesthetized.6 Our aim in this study was to assess pain in the wound and intercostal region, consistent with the area affected by the PECS1 block. Fourth, although multimodal analgesia is a part of enhanced recovery after surgery protocols,7 in this study, we focused on the requirement for additional analgesic consumption and pain scores within the first 48 h after the operation. For this reason, we concentrated our primary and secondary outcomes within this time frame rather than to study mobilization, the incidence of postoperative nausea and vomiting, patient's satisfaction with pain management, the time to hospital discharge, and quality of postoperative recovery. Finally, multiple different titles were considered, but we wanted to emphasize that the blocks were performed “intraoperatively” by the surgeon instead of the anesthesiologist. We hope we have suitably responded to the comments.