Modified Supraclavicular and Pectoral Nerves Blocks for Implantation of Intravenous Port System in Cancer Patients

Abstract

Ultrasound-guided regional anesthesia can be an effective way to achieve analgesia during implantation of permanent intravenous port systems.The aim of the study was to improve the quality of perioperative analgesia during placement of permanent intravenous port systems.Material and methods. The prospective randomized study included 93 patients with malignant neoplasms. Patients were randomized into 3 groups, 31 people each, who were implanted with a permanent intravenous port system in 2019–2022. Group 1 patients were implanted under local infiltration anesthesia (LIA). Ultrasound-guided pectoral nerves block (PECS1) in group 2 was supplemented by LIA. In group 3 ultrasoundguided selective supraclavicular (SC) nerve block was supplemented with LIA. Pain intensity was assessed on a 100 mm visual analog scale (VAS) at rest and while moving at 8, 16, 32 and 72 hours after implantation. The inflammatory postoperative stress response was assessed by the dynamics of C-reactive protein (CRP), interleukin 1-β (IL 1-β), interleukin-6 (IL-6). We also analyzed the correlation of proinflammatory cytokines levels with VAS-measured pain intensity at the stages of the study taking into account a potential relationship between IL-6 and IL-1β fluctuations and the severity of inflammatory and neuropathic pain.Results. In groups 2 (PECS1) and 3 (SC nerve block), pain intensity measured by VAS at rest and while conducting daily activities was significantly lower than in group 1 (LIA). CRP levels were also significantly lower in group 2 and 3 patients as compared to group 1. The lowest IL-6 and IL-1β concentrations after port implantation were revealed in a group 3 in 24 hours after the procedure, persisting through day 3. There was a correlationbetween proinflammatory cytokines levels and pain intensity.Conclusion. Implantation of an intravenous port system under local infiltration anesthesia causes a significant inflammatory response in cancer patients, which can be balanced by regional techniques. Selective supraclavicular nerve block in combination with a local anesthesia for intravenous port implantation demonstrated the greatest analgesic potential and requires significantly reduced amounts of local anesthetic compared to pectoral nerves block in combination with LIA, or only local infiltration anesthesia.