الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Mastectomy is one of the most common oncological surgeries performed in women around the world. Surgical resection is associated with moderate to severe acute post-operative pain. Adequate pain relief can help improve the quality of recovery and reduce the risk of chronic postoperative pain. Regional anesthetic techniques have provided better quality acute pain control and subsequently less chronic pain. The PECS block provides analgesia of the lateral mammary region. One major problem with the PECS block that it cannot block the internal mammary region. The US-guided TTP block can block multiple anterior branches of the intercostal nerves (T2-6), which dominate the internal mammary region. Therefore, a combination of the PECS block and the TTP block may be effective for postoperative analgesia in breast cancer surgery. The SAP block achieves sensory block of the anterolateral wall of the chest by depositing of local anesthetic either superficial or deep to the serratus anterior muscle. Our prospective randomized study aimed to evaluate the analgesic efficacy of combined US-guided PECS II block and TTP block versus US-guided SAP block in female patients undergoing modified radical mastectomy. The Primary Outcome was the total rescue analgesic consumption (morphine) in the first 24 h postoperatively. Secondary outcomes were postoperative VAS scores, time to first rescue analgesia request and intraoperative fentanyl consumption. This prospective randomized double-blinded study was carried out in Tanta University Hospitals from October 2020 to December 2021 on 70 female patients aged from 21-60 years undergoing unilateral modified radical mastectomy. After approval of Institutional Ethical Committee, written informed consent was obtained from each patient. Patients were randomly allocated into two equal groups by computer generated sequence through sealed opaque envelopes. Each group included 35 patients. group I (PECS II-TTP group): received unilateral US-guided PECS II block and TTP block on the side of the operation after induction of general anesthesia. group II (SAP group): received unilateral US-guided SAP block on the side of the operation after induction of general anesthesia. Measurements: - Demographic data [age (in years) and BMI (kg/m2)], ASA physical classification, and duration of surgery (in minutes). -Postoperative pain was assessed by VAS on admission to PACU and at 30 minutes and then 1,2,4,6,12,18 and 24 h postoperative. - Total dose of postoperative morphine (mg). - Time to the 1st postoperative rescue analgesia (hours). - Total dose of intraoperative fentanyl (μg). - Patient satisfaction was assessed using a 3- point scale (1= unsatisfied ,2= fair, 3= satisfied). - HR (beats/minutes) and MAP (mmHg) were measured pre-procedure and during procedure every 15 min till the end of surgery. - Any undesirable side effects during the first 24 hours were recorded and treated (e.g. pneumothorax, hematoma, nerve damage, nausea, vomiting and local anesthetic toxicity). The results of our study showed: - The two groups were comparable as regards the patient characteristics and demographic data (age, BMI and ASA, duration of surgery). - There were no statistically significant differences between the two groups as regards post-operative VAS scores at the follow-up periods, with exception at 4 and 6 hours being significantly increased in SAP group. - The total dose of post-operative morphine consumption in the first 24 hours was significantly increased in SAP group compared to PECS II – TTP group. - Time of first request of postoperative analgesia was significantly prolonged in PECS II -TTP group compared to SAP group. - Total intraoperative fentanyl consumption was insignificantly different between the two groups. - There was no statistically significant difference between the two groups as regards patient’s satisfaction. - Concerning the preoperative and intra-operative HR and MAP the results of the present study revealed no statistically significant differences between the two groups at all the follow-up periods (5, 15, 30, 45, 60, 75, 90, 105 minutes and end of surgery). - Also, the two groups were comparable regarding the incidence of nausea and vomiting, while, pneumothorax, hematoma, and local anesthetic toxicity weren’t reported in the two groups.