الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 110 |  |  |
| | | from | 110 | | |
Abstract
Breast cancer is the most frequent feminine Egyptian malignancy (38.8%), and the most used surgical intervention is modified radical mastectomy (MRM). The chest wall, axilla, and ipsilateral arm experience severe acute nociceptive as well as neuropathic pain after breast cancer surgery but in general the post-surgical acute neuropathic pain is underdiagnosed. Postoperative pain, nausea and vomiting, and anxiety are the most prevalent causes for an overnight stay following breast cancer surgery. If not adequately treated, pain will increase postoperative morbidity, delay wound healing, prolong the period of hospital stay, and leads to the development of chronic post-mastectomy pain syndrome.
Breast cancer patients’ hospital stays have been reduced as a result of the less invasive surgical techniques and the implementation of effective pain management plans, including regional anaesthetics.
ESPB is a straightforward procedure with clearly apparent sonographic features, and a catheter may be easily introduced into the plane following injection-induced distention. It is widely used nowadays with variable volumes, and concentrations, injected in many surgeries involving different anatomical locations as the fascia of Erector spinae muscle begins cranially at the base of the skull and ends caudally at the sacrum and the block can cover many dermatomes. Volumes utilised ranged from 10 to 40 mL; however, the effect of different volumes and concentrations have not yet been fully elucidated, either for the analgesic efficacy or for the drawbacks.
Its effectiveness is determined on the compartmental dispersion and distribution of LA to neighboring neural structures. The quality of the ESPB is determined by the LA’s uptake and distribution. LA can reach the thoracic PV area via diffusing anteriorly to the spinal neurons ventral ramus and dorsal ramus and through the intertransverse connective tissues.
Most studies exploring the mechanism of action of ESPB were cadaveric studies. Nevertheless, the findings of these investigations are mixed, as not all of them showed widespread dye distribution. Moreover, the cadaveric models may fail to explain the relation between LA volume, analgesic efficacy and the spread.
However, there are many limitations of the cadaveric studies. The biomechanical characteristics of cadaveric tissues differ significantly from those of live tissues, and injected fluids may not diffuse evenly over all tissue planes.
NK cells play a pivotal role in the perioperative period in surveillance and protection against cancer metastases. Studies on the effect of many anaesthetics on NKC cytotoxicity have paved the way to other new regional anaesthesia techniques to be involved in this area.
The present study was carried to investigate the effectiveness of USG ESPB by utilizing different LA volumes, with the same dose, on analgesic efficacy, dermatomal spread, immunomodulation and drawbacks in breast oncological surgeries.