Chowdhury SR, Datta PK, Maitra S
… +4 more, Rawat D, Baidya DK, Roy A, Nath S
Anaesthesiol Intensive Ther
· 2023 · PMID 37306268
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Preoperative ultrasound assessment of inferior vena cava (IVC) diameter and the collapsi-bility index might identify patients with intravascular volume depletion. The purpose of this review was to gather the existing evi...Preoperative ultrasound assessment of inferior vena cava (IVC) diameter and the collapsi-bility index might identify patients with intravascular volume depletion. The purpose of this review was to gather the existing evidence to find out whether preoperative IVC ultrasound (IVCUS) derived parameters can reliably predict hypotension after spinal or general anaesthesia. PubMed was searched to identify research articles that addressed the role of IVC ultrasound in predicting hypotension after spinal and general anaesthesia in adult patients. We included 4 randomized control trials and 17 observational studies in our final review. Among these, 15 studies involved spinal anaesthesia and 6 studies involved general anaesthesia. Heterogeneity with respect to the patient populations under evaluation, definitions used for hypotension after anaesthesia, IVCUS assessment methods, and cut-off values for IVCUS-derived parameters to predict hypotension precluded pooled meta-analysis. The maximum and minimum reported sensitivity of the IVC collapsibility index (IVCCI) for predicting post-spinal hypotension was 84.6% and 58.8% respectively, while the maximum and minimum specificities were 93.1% and 23.5% respectively. For the prediction of hypotension after general anaesthesia induction, the reported ranges of sensitivity and specificity of IVCCI were 86.67% to 45.5% and 94.29% to 77.27%, respectively. Current literature on the predictive role of IVCUS for hypotension after anaesthesia is heterogeneous both in methodology and in results. Standardization of the definition of hypotension under anaesthesia, method of IVCUS assessment, and the cut-offs for IVC diameter and the collapsibility index for prediction of hypotension after anaesthesia are necessary for drawing clinically relevant conclusions.
Anaesthesiol Intensive Ther
· 2023 · PMID 37306267
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Endoscopic submucosal dissection (ESD) is an advanced endoscopic procedure for management of gastrointestinal tumours. ESD is usually performed under sedation. However, the use of general anaesthesia (GA) has been hypoth...Endoscopic submucosal dissection (ESD) is an advanced endoscopic procedure for management of gastrointestinal tumours. ESD is usually performed under sedation. However, the use of general anaesthesia (GA) has been hypothesised to improve ESD outcomes. We performed a systematic review and meta-analysis to compare GA against sedation in ESD. A systematic literature search was performed on Cochrane Library, EMBASE and MEDLINE using the terms "General Anaesthesia", "Sedation" and "Endoscopic submucosal dissection". Original articles comparing GA versus sedation in ESD were included. The risk of bias and level of evidence were assessed by validated methods. This review is registered in PROSPERO (CRD42021275813). 176 articles were found in the initial literature search, and 7 articles (comprising 518 patients receiving GA and 495 receiving sedation) were included. Compared with sedation, GA was associated with higher en-bloc resection rates in oesophageal ESD (RR 1.05; 95% CI: 1.00-1.10; I 2 = 65%; P = 0.05). GA patients also trended towards lower rates of gastrointestinal perforation in all ESD procedures (RR 0.62; 95% CI: 0.21-1.82; I 2 = 52%; P = 0.06). Rates of intra- procedural desaturation and post-procedural aspiration pneumonia were lower in GA patients than in patients under sedation. The included studies had a moderate to high risk of bias, and the overall level of evidence was low. GA appears safe and feasible for ESD, yet high-quality trials will be required before GA can be regularly implemented for ESD.
Anaesthesiol Intensive Ther
· 2023 · PMID 37306266
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Heart rate variability (HRV) is a measure that shows the variation in time between consecutive heartbeats - a physiological phenomenon controlled by the autonomic nervous system. Over the years the analysis of this param...Heart rate variability (HRV) is a measure that shows the variation in time between consecutive heartbeats - a physiological phenomenon controlled by the autonomic nervous system. Over the years the analysis of this parameter has been used in many fields of medicine, including anaesthesiology, for scientific and research purposes. We carried out a review of the available literature on the applicability of HRV assessment in anaesthesiology. Several potential applications of HRV in clinical anaesthesia have been identified and proven feasible. As a non-invasive and relatively easy method to gauge the autonomic nervous system, HRV analysis can provide the anaesthesiologist with additional datapoints, potentially useful in assessing efficacy of a blockade and adequacy of analgesia, and in predicting adverse events. However, interpretation of HRV and generalizability of research findings can be problematic due to the multiplicity of factors that influence this parameter and bias in methods introduced by the researchers.
Nedel W, Vasconcellos A, Gunsch K
… +1 more, Rigotti Soares P
Anaesthesiol Intensive Ther
· 2022 · PMID 36734453
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Mean arterial pressure (MAP) is a key haemodynamic variable monitored in critically ill patients. The advantages of oscillometric noninvasive blood pressure (NIBP) measurement are its easy and fast methodology; however,...Mean arterial pressure (MAP) is a key haemodynamic variable monitored in critically ill patients. The advantages of oscillometric noninvasive blood pressure (NIBP) measurement are its easy and fast methodology; however, the accuracy and the precision of this measurement in critically ill patients is constantly debated. We performed a systematic review and meta-analysis of observational studies comparing oscillometric NIBP methods with invasive arterial pressure (IAP) measurements. We included studies of adult critically ill patients, which evaluated MAP in the same patient by both NIBP and IAP at any site. We included only studies comparing simultaneous measurements of arterial pressure by NIBP and IAP, reporting their results using mean difference and SD of agreement. The main outcome was to define the bias of the MAP measured by NIBP over the IAP measurement. The quality of the studies was analysed by the QUADAS 2 tool. Seven studies and 1593 patients were included in the main analysis. The oscillometric NIBP method had a mean value of -1.50 mmHg when compared with IAP (95% CI: -3.34 to 0.35; I2 = 96% for random effects model, P < 0.01). The limits of agreement for MAP varied between -14.6 mmHg and +40.3 mmHg. NIBP had an adequate accuracy regarding MAP measurements by oscillometry. Limits of agreement may thus narrow the clinical applicability in scenarios in which there is a need for a more precise management of blood pressure.
Hung Tsan S, Viknaswaran N, Lau J
… +2 more, Cheong C, Wang C
Anaesthesiol Intensive Ther
· 2022 · PMID 36734452
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Preoxygenation during endotracheal intubation is important to ensure the safety of the procedure. This systematic review and meta-analysis aimed to evaluate the efficacy of preoxygenation in the head-elevated position as...Preoxygenation during endotracheal intubation is important to ensure the safety of the procedure. This systematic review and meta-analysis aimed to evaluate the efficacy of preoxygenation in the head-elevated position as compared to the supine position. The Medline, PubMed, Scopus, Embase, and CENTRAL databases were searched systematically from inception of the study until 29 June 2021. Only randomized controlled trials (RCTs) were included. The Cochrane Risk of Bias Assessment Tool and GRADE assessment of certainty of evidence were used. Seven RCTs (n = 508) were analysed, of which 6 were included in the meta-analysis (n = 227). Six studies were carried out in the operating theatre (OT), while one was performed in the critical care (ICU) setting. Compared to the supine position, the head-elevated position significantly increased the duration of the safe apnoea period (mean difference 61.99 s; 95% confidence interval 42.93-81.05 s; P < 0.00001; I2 = 30%; certainty of evidence = high). This improvement was seen in both the obese and non-obese population (I2 = 0%). No differences were seen between both groups with regard to recovery time after apnoea, arterial oxygen tension after preoxygenation, and the incidence of adverse events. In the ICU setting, no difference was found between groups for the incidence of hypoxaemia and the lowest oxygen saturation between induction and after intubation. This meta-analysis demonstrated that the head-elevated position significantly improved the efficacy of preoxygenation during elective intubation in the OT. Clinicians should consider the head-elevated position as a starting intubating position for all patients undergoing anaesthesia in view of its many benefits and the lack of proven adverse consequences. Protocol Registration: This systematic review was registered prospectively in PROSPERO (CRD42019128962).
Anaesthesiol Intensive Ther
· 2022 · PMID 36734451
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INTRODUCTION: Hypertensive patients are known to have increased perioperative arterial blood pressure (BP) lability, which is related to cardiovascular events. Masked uncontrolled hypertensive patients are at high cardio...INTRODUCTION: Hypertensive patients are known to have increased perioperative arterial blood pressure (BP) lability, which is related to cardiovascular events. Masked uncontrolled hypertensive patients are at high cardiovascular risk. This study aimed to compare BP lability during general anaesthesia in treated hypertensive patients with normal clinic BP, between masked uncontrolled hypertension and adequately controlled hypertension. MATERIAL AND METHODS: Forty-three patients with apparently controlled BP were initially enrolled in this prospective observational study. Home BP was monitored and patients classified into diagnostic groups. Perioperative BP profiles were recorded from before anaesthesia induction until discharge from the recovery room. BP lability was assessed using 3 methods: (1) out-of-range probability, (2) standard deviation (SD) and variance (VAR), and (3) mean and time-averaged absolute change in BP from one measurement to the next (ARV and TARV). RESULTS: Sixteen masked hypertensive and 21 adequately controlled hypertensive patients were analysed. The masked group had higher of BP lability [95% CI] as measured by SD than the adequately controlled group during intraoperative and postoperative periods (SBP-SD, intraoperative 17.97 [15.33, 20.60] vs. 13.528 [11.22, 15.82], P = 0.014; postoperative 10.40 [7.65, 13.16] vs. 5.49 [2.96, 8.02], P = 0.012). MAP-SD, intraoperative 12.35 [10.70, 13.99] vs. 9.66 [8.22, 11.10], P = 0.017; postoperative 7.21 [5.05, 9,38] vs. 4.06 [2.09, 6.05], P = 0.037). ARV and TARV also revealed higher intraoperative SBP lability; non-time-averaged (mmHg) 12.40 [10.43, 14.37] vs. 9.50 [7.78, 11.22], P = 0.031 and time-averaged (mmHg min-1) 2.35 [1.95, 2,74] vs. 1.82 [1.49, 2.16], P = 0.047). CONCLUSIONS: Masked uncontrolled hypertensive patients had significantly higher BP lability in SBP and MAP during the intraoperative and immediate postoperative periods.
Saracoglu A, Saracoglu K, Ergun I
… +4 more, Yildirim M, Akca M, Demirtas C, Tetik S
Anaesthesiol Intensive Ther
· 2022 · PMID 36734450
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INTRODUCTION: This study was constructed to compare the effects of resuscitation with gelatine and hydroxyethyl starch (HES) on coagulopathy, haemodynamics, and tissue damage during an uncontrolled haemorrhagic shock mod...INTRODUCTION: This study was constructed to compare the effects of resuscitation with gelatine and hydroxyethyl starch (HES) on coagulopathy, haemodynamics, and tissue damage during an uncontrolled haemorrhagic shock model in rats. MATERIAL AND METHODS: Twenty 6-month-old Sprague-Dawley rats were included in the study and divided into 4 groups. There was no haemorrhage in the sham group. The others were randomised into haemorrhage without volume replacement (control group), haemorrhage and gelatine (group G), and haemorrhage and HES (group V). Blood samples for thromboelastogram and annexin 5 values were obtained before bleeding and after resuscitation. RESULTS: In the control group, R (16.18 ± 2.74) and K (5.8 ± 1.1) were significantly higher than in all other groups ( P = 0.001), and the TEG alpha angle was 39.54 ± 5.94°, which was found to be significantly lower than in the sham group ( P = 0.001). In group V, the TEG MA value was found to be significantly lower at 30.54 ± 8.89 ( P = 0.001). The annexin A5 value was significantly higher in the control group, group V, and group G than in the sham group and was highest in the control group ( P = 0.001). Lung damage score measurement was 0.60 ± 0.19 in the control group, higher than in the gelatine and HES groups ( P = 0.001). CONCLUSIONS: Lung tissue damage and coagulation were positively affected by HES or gelatine resuscitation. A reduction in clot formation in the HES group might be observed due to the possible negative effect on platelets. Therefore, we concluded that the use of gelatine might be advantageous until blood transfusion is initiated in traumatic haemorrhagic shock.
Moreno I, Tsamassiottis S, Ettinger M
… +2 more, Fischer-Kumbruch M, Przemeck M
Anaesthesiol Intensive Ther
· 2022 · PMID 36734449
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INTRODUCTION: Total knee arthroplasty (TKA) is associated with severe postoperative pain and significant chronification. The lengthy debate is on-going regarding the best balance between pain management, safety, and func...INTRODUCTION: Total knee arthroplasty (TKA) is associated with severe postoperative pain and significant chronification. The lengthy debate is on-going regarding the best balance between pain management, safety, and functional rehabilitation. MATERIAL AND METHODS: Fifty adult patients scheduled for primary unilateral TKA were randomly divided into 2 groups: continuous femoral nerve blockade (FNB; n = 25) and local infiltration analgesia (LIA; n = 25). We compared FNB and LIA in terms of function (primary outcome; number of steps, recorded using a step-tracking watch), pain scores using the visual analogue scale (VAS), opioid consumption (morphine equivalents), muscle strength (Janda Score), side effects, and complications until postoperative day 5. The results are presented as (mean ± SD). RESULTS: After excluding one patient, 49 were analysed (25 FNB, 24 LIA). There were no differences between the groups in the primary outcome. The VAS score (day 0: 23 ± 17.7 vs. 32.8 ± 21.5; P = 0.101; day 1: 31.0 ± 22.3 vs. 41.7 ± 25.3; P = 0.112) and mean opioid consumption (day 0: 0.39 ± 0.17 vs. 0.50 ± 0.38; P = 0.655; day 1: 0.60 ± 0.27 vs. 0.71 ± 0.38; P = 0.406) did not differ significantly between the groups. Muscle strength was significantly lower in the FNB group on days 0 (3.05 ± 1.67 vs. 4.35 ± 0.91; P = 0.009) and 1 (2.71 ± 1.57 vs. 3.67 ± 1.18; P = 0.030). Side effects and complications had a similarly low incidence in both groups, and except for constipation (FNB < LIA) no difference was seen. CONCLUSIONS: Based on the results of this study, both FNB and LIA are associated with similar outcomes, and one cannot be recommended over the other.
Nadeem R, Husseini M, Rajendran I
… +7 more, Latif A, Mahmoud M, Mathews M, Alshaikh SayedAhmed Y, Sharma E, Salama Khalil M, Rafeeq A
Anaesthesiol Intensive Ther
· 2022 · PMID 36734448
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INTRODUCTION: COVID-19 has caused 4 million deaths as of 24 August 2021. A significant number of patients were admitted to undesignated ICU areas before transfer to a desig-nated ICU owing to the unavailability of ICU be...INTRODUCTION: COVID-19 has caused 4 million deaths as of 24 August 2021. A significant number of patients were admitted to undesignated ICU areas before transfer to a desig-nated ICU owing to the unavailability of ICU beds. We aim to compare the mortality and length of stay of patients in these 2 areas. MATERIAL AND METHODS: We retrospectively studied all critically ill patients with COVID-19 pneumonia who were admitted to Dubai hospital between 1 January 2020 and 30 June 2020. Patients who transferred to wards other than designated ICU constitute cases, while those who were admitted directly to designated ICUs constitute controls. The demographics, clinical parameters, and treatment profile of these patients were recorded and compared. Mortality and length of stay were calculated. RESULTS: The sample includes 239 subjects (admitted to an undesignated ICU ward [n = 107] and directly admitted to a designated ICU ward [n = 132]). Patients admitted to an undesignated ICU had extra transfers between wards and had more days on MV (median [IQR] 18 (19) vs. 11 (14); P = 0.001), greater length of stay in the ICU (median [IQR]) 21.5 (19) vs. 15 (14); P = 0.001), and greater length of stay in hospital (median [IQR] 32 (28) vs. 21 (26); P = 0.001). Multiple logistic regression analysis showed that patients treated at an undesignated ICU have better survival (odds of death for patients cared for at an undesignated ICU was 0.347 with CI 0.178-0.676; P = 0.002). Multiple linear regression analysis also showed that patients treated at an undesignated ICU had longer stay - 4.2 days, CI 1.3-7.13, P = 0.004). CONCLUSIONS: Admission to an undesignated ICU impacts mortality and length of ICU and hospital stay.
Anaesthesiol Intensive Ther
· 2022 · PMID 36734447
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PURPOSE: The mean systemic filling pressure (Pms) plays a central role for our understanding of the circulation. In a retrospective analysis of a clinical trial, we studied whether Pms indicates fluid responsiveness and...PURPOSE: The mean systemic filling pressure (Pms) plays a central role for our understanding of the circulation. In a retrospective analysis of a clinical trial, we studied whether Pms indicates fluid responsiveness and whether Pms can indicate an anaesthesia-induced increase of the unstressed blood volume, which is the volume that does not increase the transmural pressure. METHODS: An analogue to P ms based on cardiac output, the mean arterial pressure and the central venous pressure, abbreviated to P msa , were calculated in 86 patients before induction of general anaesthesia and before 3 successive bolus infusions of 3 mL kg -1 of colloid fluid. An increase in stroke volume of ≥ 10% from a bolus infusion indicated fluid responsiveness. Receiver operator characteristic (ROC) curves were used to find the optimal cut-off for P msa to indicate fluid responsiveness. Changes in blood volume were estimated from anthropometric data and the haemodilution. RESULTS: Pmsa was lower in fluid responders than in non-responders before induction (13.2 ± 2.2 vs. 14.7 ± 2.7 mmHg; mean ± SD, P < 0.01) and after induction of general anaesthesia (11.4 ± 2.1 vs. 12.8 ± 2.1 mmHg; P < 0.006). ROC curves showed that 14 mmHg before anaesthesia and 12 mmHg after anaesthesia induction served as optimal cut-offs for P msa to indicate fluid responsiveness. A linear correlation between P msa and blood volume changes suggested that the anaesthesia increased the unstressed blood volume by 1.2 L. CONCLUSIONS: P msa was lower in fluid responders than in non-responders. General anaesthesia increased the need for blood volume by 1.2 L.
Anaesthesiol Intensive Ther
· 2022 · PMID 36734446
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INTRODUCTION: The search for an effective sedation schedule in managing delirium tremens that would ensure an adequate sedation level and good safety profile is an urgent problem of modern intensive care medicine. In thi...INTRODUCTION: The search for an effective sedation schedule in managing delirium tremens that would ensure an adequate sedation level and good safety profile is an urgent problem of modern intensive care medicine. In this respect, the use of dexmedetomidine combined with magnesium preparations seems to be promising. MATERIAL AND METHODS: A quasi-randomized prospective observational study was conducted on 80 patients with alcoholic delirium, who were divided into 4 groups. Assessment parameters were delirium duration, mean arterial pressure and heart rate, and plasma magnesium, urea, creatinine, transaminase, cortisol, and serotonin levels. The control-group patients underwent standard sedation therapy with benzodiazepines. In group 1, standard sedation was supplemented by magnesium sulphate. In group 2, dexmedetomidine infusion was used. In group 3, dexmedetomidine was supplemented by the correction of hypomagnesemia. RESULTS: The duration of delirium proved to be significantly shorter in all study groups (3.4 ± 0.6 days in group 1; 1.55 ± 0.61 days in group 2) as compared to the control (5.4 ± 1.48 days), P < 0.001, being the shortest in group 3 (1.1 ± 0.18 days), P < 0.001. Cases of hypotension were detected only in the control group (2 cases [10%]) and group 1 (4 cases [20%]). The patients of groups 2 and 3 showed significant improvement in plasma levels of cortisol (16.7 ± 2.25 nmol L-1; 15.62 ± 1.63 nmol L-1) compared with the control (18.77 ± 2.76 nmol L-1), P = 0.019; P = 0.003. Serotonin level was higher in the experimental group 3 (87.8 ± 7.32 ng mL-1) as compared to the control (62.81 ± 9.81ng mL-1) and group 2 (71.73 ± 9.61 ng mL-1), P < 0.001. CONCLUSIONS: Dexmedetomidine infusion combined with magnesium sulphate proved to be effective in the treatment of patients with alcohol delirium.
Chapela S, Muscogiuri G, Barrea L
… +7 more, Frias-Toral E, Burgos H, Ricart M, Muryan A, Schiel A, Alonso M, Alberto Stella C
Anaesthesiol Intensive Ther
· 2022 · PMID 36734445
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INTRODUCTION: Sepsis is a syndrome of physiological, pathological, and biochemical disorders with several processes co-occurring; reactive oxygen species (ROS) production and apoptosis are 2 of them. Succinate is a Krebs...INTRODUCTION: Sepsis is a syndrome of physiological, pathological, and biochemical disorders with several processes co-occurring; reactive oxygen species (ROS) production and apoptosis are 2 of them. Succinate is a Krebs cycle intermediate that is oxydized in complex II of the mitochondria. This study aims to investigate the influence of succinate infusion on these processes. MATERIAL AND METHODS: Sepsis was induced with caecal ligation and puncture in 200 gr Sprague Dawley rats. Four groups were formed with 10 animals (1 - control, 2 - succinate, 3 - sepsis, and 4 - sepsis + succinate). 5 mmol kg-1 of intraperitoneal succinate were administered twice in groups 2 and 4. ROS and caspase-3 levels were measured. RESULTS: Overall, ROS levels (P = 0.017), but not caspase-3 levels (P = 0.89) differed significantly between the groups. The succinate administration reduced serum ROS levels (group 4 vs. 3) in a statistically significant way [0.0623 units (95% CI: 0.0547-0.0699) vs. 0.0835 (0.06-0.106), P = 0.017)], but it did not reduce serum caspase-3 levels (P = 0.39). There was no correlation between serum ROS levels and serum caspase-3 levels. CONCLUSIONS: In this model, ROS levels were reduced with succinate infusion, but caspase-3 levels were not. In addition, ROS levels and apoptosis levels are not correlated, which suggests that those processes occur at different times.
Lechowicz-Głogowska B, Uryga A, Weiser A
… +5 more, Salomon-Tuchowska B, Burzyńska M, Fortuna W, Kasprowicz M, Tabakow P
Anaesthesiol Intensive Ther
· 2022 · PMID 36734444
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INTRODUCTION: An awake craniotomy (AC) is the gold standard for the resection of supra-tentorial brain tumours in eloquent areas. Intraoperative monitoring "on-demand" of essential eloquent brain functions and the increa...INTRODUCTION: An awake craniotomy (AC) is the gold standard for the resection of supra-tentorial brain tumours in eloquent areas. Intraoperative monitoring "on-demand" of essential eloquent brain functions and the increasing need to preserve higher intellectual functions during surgery requires a unique anaesthetic approach during AC. Dexmedetomidine is considered the first-choice pharmacological agent for sedation during AC. MATERIAL AND METHODS: Twenty-six patients with a single brain tumour located in areas of eloquent brain function were enrolled in this prospective study. The patients underwent AC under conscious sedation. Motor-evoked potentials and brainstem-evoked auditory potentials were measured using neurophysiological tests during surgery to assess brain potentials. Intraoperative brain relaxation was reached using a modified Bristow scale. Neuromonitoring and psychological tests were maintained until meningeal closure. RESULTS: All operations were carried out successfully, and no reoperations were needed. No significant impact on circulatory and respiratory parameters was observed during conscious sedation based on dexmedetomidine. Neither instrumental airway support nor conversion to general anaesthesia was necessary. Brain relaxation was good in 84% of cases. Intraoperative epileptic episodes were observed in 15% of the patients. Neuro-logical and psychological monitoring was satisfactory. Unaltered muscle force was observed postoperatively in 88% of the patients. CONCLUSIONS: AC performed under conscious sedation, and dexmedetomidine infusion without instrumental airway support, was safe and well-tolerated by patients with comfortable physiological sleep for most of the procedure. This approach to AC was associated with minimal risk of perioperative adverse events and may be particularly beneficial in patients with severe comorbidities.
Tavares Mendonça F, de Assis Feitosa Junior A, Nogueira H
… +2 more, Roncolato H, Sousa Goveia C
Anaesthesiol Intensive Ther
· 2022 · PMID 36458667
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INTRODUCTION: The benefits of type I/II pectoral nerve blocks (PECS I/II), which can be dose dependent, have been examined in different studies. Nonetheless, few randomised trials have been performed in South America. Th...INTRODUCTION: The benefits of type I/II pectoral nerve blocks (PECS I/II), which can be dose dependent, have been examined in different studies. Nonetheless, few randomised trials have been performed in South America. The present randomised trial examined the efficacy of PECS I/II with a higher dose of the local anaesthetic to manage perioperative pain after mastectomy in Brazil. MATERIAL AND METHODS: This was a randomised, parallel, single-centre, and single-blind trial. Eighty participants undergoing elective mastectomy were randomised (1 : 1) to receive PECS I/II plus ultrasound-guided ropivacaine (0.5%) or standard general anaesthesia. The primary outcome was pain intensity at rest 24 hours after surgery, assessed with a numerical rating scale. Haemodynamic outcomes, consumption of opioids, anaesthe-tics and antiemetics, and post-anaesthetic recovery times were also recorded. RESULTS: Sixty participants (75%) completed the study. The mean age was 54 years, with 57% of participants undergoing mastectomy and 43% undergoing quadrantectomy. Median pain intensity (interquartile range) at rest (24 h postoperatively) was lower in the PECS I/II group compared to the control group: 0 (0-1.75) vs. 1 (1-2), P = 0.021. A smaller number of patients in the PECS I/II group required intraoperative fentanyl (23.3% vs. 83.3%; P < 0.001) and postoperative tramadol (20.0 vs. 76.7%; P < 0.001). Mean doses of fentanyl and tramadol were about 4-5 times lower in the PECS I/II group (P < 0.001). PECS I/II significantly reduced sevoflurane consumption during surgery (P = 0.01). No difference was observed regarding adverse effects. CONCLUSIONS: PECS I/II blockade with high-dose local anaesthetic is efficacious and safe, resulting in lower levels of perioperative pain after mastectomy compared to standard general anaesthesia.