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Pectoral nerves I block is associated with a significant motor blockade with no dermatomal sensory changes: a prospective volunteer randomized-controlled double-blind study

  • Jean Desroches
  • Marc Belliveau
  • Carole Bilodeau
  • Michel Landry
  • Maxim Roy
  • Pierre Beaulieu
Reports of Original Investigations
  • 202 Downloads

Abstract

Purpose

The pectoral nerves (PECS) I block, first described in 2011 for surgery involving the pectoralis muscle, has principally been used for breast cancer surgery. No formal evaluation of its differential motor- and sensory-blocking abilities has been reported. We hypothesize that the PECS I block will produce a motor block of the pectoralis muscles with diminished upper limb adduction strength as measured with a handheld dynamometer.

Methods

We conducted a PECS I block in a randomized placebo-controlled trial in six healthy subjects who received 0.4 mL·kg−1 of 0.9% saline (placebo) on one side and bupivacaine (0.25% with 1:400 000 epinephrine) on the other. We measured both upper limb adduction strength with a dynamometer and sensory skin levels over the thorax.

Results

The mean (standard deviation [SD]) adductor strength evaluated before the block was 119.4 (20.7) Newtons (N). After the PECS I block with bupivacaine, the mean (SD) strength of 54.2 (16.3) N was compared with 116.0 (30.4) N in the placebo group (difference in means 61.8 N; 95% confidence interval [CI], 27.8 to 95.8 N; P = 0.005), showing a 54.6% (95% CI, 43.6 to 65.6%) reduction in adductor strength. There was no difference in dermatomal skin sensory testing between the placebo and bupivacaine sides.

Conclusions

This study shows that a PECS I block produces motor blockade as shown by reduced upper limb adductor strength without any overlying dermatomal sensory loss.

Trial registration

www.clinicaltrials.gov (NCT03040167) 2 February 2017.

Le bloc I des nerfs pectoraux est associé à un bloc moteur significatif sans modifications de la sensibilité dermatomale : étude prospective contrôlée à double insu chez des volontaires

Résumé

Objectif

Le bloc I des nerfs pectoraux (PECS), décrit pour la première fois en 2011 pour la chirurgie impliquant le muscle grand pectoral, a été principalement utilisé pour la chirurgie carcinologique du sein. Aucune évaluation formelle de ses capacités de blocage différentiel moteur ou sensitif n’a été publiée. Nous avons émis l’hypothèse que le bloc PECS I induit un bloc moteur des muscles pectoraux avec une diminution de la force d’adduction du membre supérieur, mesurée par un dynamomètre portatif.

Méthodes

Nous avons réalisé des blocs PECS I au cours d’un essai randomisé contrôlé par placebo chez six sujets en bonne santé qui ont reçu 0,4 mL·kg−1 de solution saline à 0,9% (placebo) d’un côté et de la bupivacaïne (0,25% avec de l’épinéphrine au 1/400 000) de l’autre côté. Nous avons mesuré la force d’adduction des deux membres supérieurs avec un dynamomètre et les niveaux de sensibilité cutanée sur le thorax.

Résultats

La force moyenne de l’adducteur (écart-type [ET]) évaluée avant le bloc était de 119,4 (20,7) Newtons (N). Après le bloc PECS I avec la bupivacaïne, la force moyenne (ET) était de 54,2 (16,3) N comparée à 116,0 (30,4) N dans le groupe placebo (différence des moyennes 61,8 N; intervalle de confiance à 95% [IC] : 27,8 à 95,8; P = 0,005), démontrant une baisse de 54,6% (IC à 95% : 43,6 à 65,6%) de la force d’adduction. Il n’y a pas eu de différence pour les tests de sensibilité des dermatomes cutanés entre les côtés ayant reçu le placebo ou la bupivacaïne.

Conclusions

Cette étude démontre qu’un bloc PECS I entraîne un bloc moteur mis en évidence par la baisse de la force d’adduction des membres supérieurs sans perte de la sensibilité des dermatomes sus-jacents.

Enregistrement de l’essai clinique

www.clinicaltrials.gov (NCT03040167) 2 février 2017.

Notes

Acknowledgements

The authors thank Vincent Morissette-Thomas for his statistical assistance and the volunteers who participated in the study.

Conflicts of interests

The authors declare no conflicts of interest.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Jean Desroches, Marc Belliveau, Carole Bilodeau, Michel Landry, and Pierre Beaulieu were involved in the study design and planning. Jean Desroches, Marc Belliveau, Carole Bilodeau, and Michel Landry were involved in the study conduct. Jean Desroches, Marc Belliveau, Carole Bilodeau, Maxim Roy, and Pierre Beaulieu were involved in the data analysis. Jean Desroches, Marc Belliveau, Maxim Roy, and Pierre Beaulieu were involved in writing the manuscript. All authors were involved in revising the manuscript.

Funding

The authors have no sources of funding to declare for this manuscript.

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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyHôtel-Dieu de St JérômeSt JérômeCanada
  2. 2.Department of PhysiotherapyHôtel-Dieu de St JérômeSt-JérômeCanada
  3. 3.Department of AnesthesiologyCentre Hospitalier de l’Université de MontréalMontrealCanada

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