الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
ERAS strategy is widely used now in all surgeries especially in major colorectal surgeries. Nowadays, the trend is applying ERAS protocol according to type of surgery.
Ultrasound guided PECs I, II block has improved the success rate of analgesia in all breast surgeries and can avoid complications of other analgesic modalities (hemodynamic changes occurring in epidural anesthesia)
Anesthesia doctors should identify anatomical landmarks on applying the PECs I, II block.
This study was applied on 70 adult female patients ASA II, III admitted to (Alexandria Main University Hospital) to receive breast surgery
Exclusion criteria:
1- Patient refusal
2- Patient with DM
3- Patients who are not able to properly describe postoperative pain
4- Coagulopathy
5- Preoperative opioid consumption
6- History of allergy to studied medications
7- Breast cancer with distant metastases
8- Pregnancy
9- BMI ≥30kg/ m2
Patients were randomly categorized using closed envelope method into two equal groups 35 each of them.
group I: General anesthesia with PECs I, II block
group II: General anesthesia with PECs I, II block and ERAS protocol.
Patients were assessed preoperatively through taking full medical and surgical history, clinical point of examination and routine laboratory investigations and explanation of the block procedure occurred to patients preoperatively
General anesthesia was induced in both groups as following: Patients were put in supine position and pre-oxygenated with 100% oxygen by a face mask for 3 minutes. An appropriate size laryngeal mask airway is positioned in the back of the throat, and the cuff was inflated with appropriate volume of air.
The patients were mechanically ventilated and general anesthesia was maintained with sevoflurane (2%) in 100% oxygen and incremental doses of atracurium (0.1mg kg-1).
According to ERAS group: surgery doctors were asked to prepare surgical site by Chlorhexidine and patient’s temperature was maintained above 36° (by using warmer) with fluid resuscitation by bolus dose 10ml\kg then 4ml\kg\h (or according to intraoperative losses).
group I: General anesthesia by (propofol 2.5mg/kg + fentanyl 2µ /kg + atracium0.5mg/kg) with Pectoralis Muscle Block (PECs I, II block) before skin incision.
group II: General anesthesia by (propofol 2.5mg/kg + fentanyl 2µg/kg + atracium0.5mg/kg) with PECs I, II block before skin incision and application of ERAS Protocol methods.
The following measurements were covered:
1-Length of stay
2-Postoperative antiemetic requirement
3-Episodes of postoperative vomiting
4-Pain assessment on NPS from 0 to 10
Pain recorded as following:
Immediately postoperative
Hourly for the first 4 hours
Every 4 hours for the rest of the first 24 postoperative hours
5- Time to the first rescue opioid analgesic dose: time from end of surgery to first analgesic opioid dose and opioid consumption.
6- Patient ambulation time
7- Postoperative complications in the first 24 hours
Local anesthetic toxicity
Hematoma
Pneumothorax
The results of this study were:
There was statistical difference in pain assessment on NPS and time to first opioid rescue and opioid consumption.
There was no significant difference in LOS and antiemetic requirement and episodes of vomiting and ambulation time and postoperative complications .
According to complications there were no complications in the current study.