الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
Regional anesthesia techniques for breast surgery hold great
promise for patients in terms of improved acute pain control with chronic
pain prevention while reducing opioid-related side effects. The notion
that anesthetic choice may impact the cancer recurrence rate is fascinating
and exciting for both patients and physicians.
The pectoral nerve block (Pecs block) is a recently described, easy
and reliable superficial block that targets the lateral and median pectoral
nerves at an interfascial plane between the pectoralis major (PMM) and
minor (Pmm) muscles. It can be used for providing surgical anaesthesia
and postoperative analgesia during breast surgery.
Our study prospectively compared Pecs blocks with 20ml lidocaine
2% + 20ml bupivacaine 0.5% (group I) to Pecs block with 20ml
bupivacaine 0.5% + 18 ml normal saline + 100 mcg fentanyl (2 ml)
(group II) combined with general anesthesia in modified radical
mastectomy (MRM) surgery for producing intraoperative and
postoperative analgesia. Sixty female patients were chosen aged from 20
to 60 years, with ASA physical status 1-III and a body mass index less
than 30 kg/m2.
Our primary outcome measure was time to the first call for
analgesia starting from the administration of the pectoral nerve block till
the patient asks for analgesia postoperatively. Secondary measures were
perioperative hemodynamic monitoring, the total amount of intraopertive
fentanyl, the amount of analgesics used in the first 24 postoperative
hours, postoperative nausea and vomiting (PONV) and detection of any
complication.
group II showed a highly significant increase in time of first call
for analgesia and a highly significant decrease in analgesic requirement in
first 24 hours than group I. There was a highly significant difference
between the two groups as regards visual analogue scale; it was higher in
group I in the period from 4 – 8 hours as they felt pain earlier than
group II. While in the period from 20 – 24 hours it was higher in the
second group as they started to feel pain. The duration of analgesia was
longer with group II (22.3±1.68) hours than group I (6.31±0.54) hours.
Only 10% of patients in group II required paracetamol as a postoperative
analgesic requirement compared to 36.7% who required paracetamol and
63.3% who required paracetamol plus ketolac in group I.
As regards hemodynamic monitoring, after induction of anesthesia
and due to stress response of surgery there was increase in heart rate and
mean blood pressure and return to normal range with the onset of
analgesic effect of pecs block which is slightly earlier for group I at about
10min compared to about 14min for group II. During postoperative
period there were minimal hemodynamic changes in both groups .
In group II only two patients suffered from postoperative nausea
and one patient suffered from purities due to the effect of fentanyl . No
other complications could be detected and no signs of local anesthetics
toxicity could be detected in spite of using a large volume of anesthetics.
In our study, we concluded that Pecs block is a simple technique
that produces good analgesia for radical breast surgery without an
apparent complications. Using fentanyl as adjuvant to bupivacaine
increased the time of first call for analgesia and decreased the analgesic
requirements in first 24 hours.