Implementation of the PECS II Block in Mastectomy Patients

Abstract

Problem: Acute pain associated with mastectomies occurs 60% of the time in the postoperative phase. In addition to acute pain, these patients can develop chronic pain and upper arm restrictions due to untreated pain. There has been a shift in utilizing regional anesthetic techniques to counteract increased opioid consumption and misuse. At a community hospital located in Maryland, those undergoing mastectomies required Dilaudid, a narcotic, 80% of the time for postoperative pain. Purpose: The purpose of this Quality Improvement Project was to implement a protocol for anesthesia providers to utilize when performing the PECS II nerve block to reduce postoperative pain in mastectomy patients. Methods: The quality improvement project took place over 15 weeks. The PECS II nerve block protocol was readily available for anesthesia providers for local anesthetic dosing and criteria. Compliance with the protocol was measured along with pain scores in the postoperative area. Results: There were a total of 24 mastectomy cases. The compliance rate during weeks 1-3 was 50%. Compliance for weeks 4 through 6 was 33%. There was a 50% compliance rate for weeks 7-9. The median increased from 16.5% in weeks 9-11 to 75% for weeks 12-15. Out of the patients who received a PECS II nerve block, 11 out of those 13 had pain scores of less than five throughout the entire postoperative period. For those who did not receive a PECS II nerve block, only seven out of 11 patients had a pain score of less than five in the first 15 minutes of entering the post anesthesia care unit (PACU). Conclusions: The number of anesthesia providers adhering to the PECS II nerve block protocol steadily increased as more providers were trained to perform the block. The incidence of pain scores above five in those who received the block was considerably lower. Out of those patients, 92% receiving the block had a pain score of less than five throughout their stay in the PACU.