Efficacy of Pectoral Nerve II Block for Flap Dissection-Related Pain Following Robot-Assisted Transaxillary Thyroidectomy: A Prospective, Randomized Controlled Trial

Chae, Min Suk; Kim, Kwangsoon

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Korean J Anesthesiol > Epub ahead of print

Clinical Research Article

DOI: https://doi.org/10.4097/kja.24914 [Epub ahead of print]
Published online February 24, 2025.

Efficacy of Pectoral Nerve II Block for Flap Dissection-Related Pain Following Robot-Assisted Transaxillary Thyroidectomy: A Prospective, Randomized Controlled Trial

Min Suk Chae¹

, Kwangsoon Kim²

¹Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
²Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

Corresponding author: Kwangsoon Kim, Tel: +82-2-2258-6361, Fax: +82-2-2258-2138,
Email: noar99@naver.com

Received: 26 December 2024 • Revised: 31 January 2025 • Accepted: 10 February 2025

Abstract

Background
Robot-assisted transaxillary thyroidectomy (RATT) involves extensive flap dissection, leading to significant postoperative pain. This study evaluated the efficacy of pectoral nerve II (PECS II) block in pain relief, opioid reduction, and recovery enhancement.
Methods
This prospective, randomized controlled trial included 83 patients undergoing elective RATT for thyroid conditions. Patients were assigned to the block group (n = 42) or non-block group (n = 41). Pain was assessed using the visual analog scale (VAS) at 1, 4, 24, and 48 hours postoperatively. Secondary outcomes included opioid consumption and Quality of Recovery-15 (QoR-15K) scores at discharge.
Results
The PECS II block group had significantly lower VAS scores at 1 h (3.6 ± 2.5 vs. 6.3 ± 2.3, P < 0.001), 4 h (2.6 ± 2.1 vs. 4.3 ± 2.5, P = 0.002), and 24 h (2.0 ± 1.6 vs. 3.2 ± 2.0, P = 0.002). Opioid consumption was significantly lower in the block group (median: 1 [0.75, 3] vs. 3 [2, 3.5], P = 0.001). QoR-15K pain subdimension scores were higher in the block group (14.5 [12, 17] vs. 10 [8, 14], P < 0.001), while other recovery aspects were comparable.
Conclusions
The PECS II block significantly reduces pain and opioid use in RATT patients, enhancing recovery quality. This opioid-sparing approach supports multimodal pain management, ensuring safer and more comfortable postoperative recovery.

Key Words: Opioid consumption; Postoperative pain; Flap dissection; Pectoral nerve II block; Quality of recovery; Robot-assisted transaxillary thyroidectomy