Making Breast Cancer Surgery Easier and Faster to Recover From

A new protocol at New Jersey’s Hackensack University Medical Center is in the process of radically altering the recovery process for patients with breast cancer who undergo surgery.

CURE discussed this regional anesthesia technique, known as PEC I and II blocks, with breast surgeon Dr. Christopher M. McGreevy, associate chief of Breast Surgery at Hackensack University Medical Center.

CURE: What are PEC I and II blocks, and how can they help patients?

McGreevy: The PEC block is essentially a nerve block that we use as an adjunct to anesthesia during surgery for women that have breast cancer, and there are multiple different applications for the pectoral nerve block. The nerve block itself is not new; it is how we are applying the nerve block that is new and novel.

In general, patients that have breast cancer and choose to have mastectomies undergo surgery with general anesthesia, which includes lots of medications, a breathing tube, and, most of the time, patients are given narcotics during surgery to help with the pain, even though they are put asleep with the anesthesia. General anesthesia has multiple side effects, including nausea and vomiting being the most common, sore throat, and patients overall not feeling great after general anesthesia. For anyone that has had surgery, they know that groggy feeling for a day or two after the operation.

How we are applying the pectoral nerve blocks is that instead of putting patients under general anesthesia, we do these pectoral nerve blocks before surgery to block the nerve sensations and decrease the amount of pain that happens during surgery, and then the patients are only under deep sedation, similar to what would happen if a patient had a colonoscopy. No breathing tube is placed, no narcotics are given during surgery, and patients have significantly lower rates of nausea, vomiting, and grogginess. After surgery, all the patients wake up and feel pretty much back to normal fairly quickly, and they go home the day of their operation.

That sounds like such a huge pivot in terms of overall quality of life.

One hundred percent. We have done it in a select few patients at Hackensack University Medical Center so far, and the patients that have been able to undergo this procedure felt pretty normal after surgery, which is outstanding. Some of the patients told me they went to the mall or they walked three miles the day after their operation. Patients going through cancer have a lot to deal with; not only surgery and recovery from surgery, but potentially radiation, chemotherapy, and other treatments. If we can make the day of surgery and a couple of days after surgery easier for them, it can make a world of difference for their overall cancer treatment.

Is there any particular patient population for whom this procedure is well suited or not?

Patients that are at high risk for complications with anesthesia, patients that potentially have breathing issues, or patients that could not undergo sedation for certain reasons would not be good candidates for this. Right now, we have only done it in a handful of patients, so we are very selective, but our goal is, as we start doing more, to expand it to most patients. Most patients should be able to undergo this procedure because the nerve block itself is done by the anesthesiologist before surgery, and the only things that we use are an ultrasound and a needle to inject numbing medication.

How many patients have undergone this procedure so far at Hackensack University Medical Center?

We have done somewhere between five to ten. We started doing the procedure on patients that were getting lumpectomies, so a smaller surgery for breast cancer. We did approximately 40 patients with lumpectomies. We found that it worked very well in our lumpectomy patients. So, then we started extrapolating and doing it on our mastectomy patients, which is a much bigger, longer operation with more pain involved during the surgery.

Is there anything else about this procedure that you would like the CURE readership to know?

The other thing that is advantageous about the pectoral nerve blocks, and the reason why pectoral nerve blocks have been used for a long time, is that we can give medication during the nerve block that can last up to 48, sometimes 72, hours to make the patient pain-free for the first three days after surgery.

How pectoral nerve blocks originated was really to help with postoperative pain. Patients would get the nerve block and then still get general anesthesia. We have taken it a step further by doing the nerve block and now eliminating the need for general anesthesia and just giving patients sedation. So not only do they do better on the day of surgery and the day after, but their pain is also well controlled even for two to three days after surgery, to the point where the patients that we have done this protocol on have only taken Tylenol after surgery and have not required narcotics.

Transcript has been edited for clarity and conciseness.

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