Regional Anesthesia With Pectoral Blocks as a Non-inferior Approach for Mastectomy Analgesia: A Quality Improvement Study

Introduction Breast cancer is one of the most common female malignancies in the United States and often necessitates surgical interventions that carry a substantial risk of postoperative pain. Pectoral nerve blocks have emerged as a simpler alternative for providing regional perioperative analgesia to the chest wall in breast cancer surgery. This retrospective study evaluated the impact of implementing a novel regional anesthesia protocol centering on the use of pectoral nerve blocks for patients undergoing radical mastectomy at a small regional hospital in Spartanburg, South Carolina. Methods A retrospective study was conducted to examine the effects of peripheral nerve blocks, specifically pectoral nerve blocks, on intra- and postoperative milligram morphine equivalent consumption and postoperative length of stay for 168 mastectomy patients at Spartanburg Medical Center between June 2022 and June 2023. The association between anesthesia regimen received, length of stay, and perioperative milligram morphine equivalents consumed was examined using Wilcoxon rank sum testing. Results Patients who received pectoral nerve blocks (n = 23) demonstrated a 31.53% decrease in milligram morphine equivalent consumption in comparison to patients who received other types of peripheral nerve blocks within the same perioperative window. The length of stay for study patients who received pectoral nerve blocks (1.07 days) was grossly comparable to that for patients who received any other type of regional nerve block for their mastectomy over the course of the investigation (0.92 days). Conclusions For the provision of regional analgesia for mastectomy, pectoral nerve blocks were demonstrated to be non-inferior to other types of peripheral blocks traditionally used in this setting. After the change in protocol to pectoral nerve blocks in January 2023, mastectomy patients receiving pectoral nerve blocks required less perioperative pain medication, with no significant adverse impact on length of stay.