الفهرس 
ANATOMY OF THE THORACIC WALL AND BREASTOnly 14 pages are availabe for public view
 |  | from | 107 |  |  |
| | | from | 107 | | |
Abstract
B
reast surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anaesthesia techniques may improve post-operative analgesia for patients undergoing breast surgery (Bolin et al., 2015).
Since the concept of day case surgeries are getting more popular, surgeons and anaesthesiologists are trying their best to provide adequate post-operative analgesia. The proper management of post-operative pain ensures early ambulation of patients and obviates many post-operative complications (Liu and Wu, 2007).
Patient-controlled analgesia (PCA) is a delivery system that allows the patient to self-administer predetermined small doses of analgesic medication for pain relief. Intravenous (IV)-PCA using opioids has been widely adopted for postoperative pain management. Morphine is commonly used for IV-PCA due to its strong analgesic with low cost, and evidence of efficacy (Niiyama & Matsuoka, 2016).
The pectoral nerves block (Pecs block) is an easy and reliable superficial block. Once the pectoralis muscles are located under the clavicle the space between the two muscles is dissected to reach the lateral pectoral and the medial pectoral nerves. The main indications are breast expanders and sub-pectoral prosthesis where the distension of these muscles is extremely painful. A second version of the Pecs block is called ‘‘modified Pecs block’’ or Pecs block type II. This novel approach aims to block at least the pectoral nerves (Blanco et al., 2012).
The primary aim of this study is to compare the efficacy of PECS block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques.
• The participants were allocated randomly into two groups of 26 patients each:
o group A: Patients received general anaesthesia followed by PECS block at the end of the operation before extubation.
o group B: Patients received general anaesthesia followed by the PCA at the end of surgery after extubation.
• The two groups were adequately monitored and assessed post-operatively for time interval after which there was be requirement of first supplemental doses of analgesia (which was the time when VAS score happened to be ≥4). Total doses of analgesia which were given in first 24 hours post-operative.
• Compare post-operative nausea & vomiting for both group.
The Results shows that the VAS score in the PECS group was statistically significantly lower at the 1st, 2nd and 4th hours. In this case, the use of PECS for postoperative analgesia is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect as the nausea and vomiting is significantly higher in the PCA group than the PECS group at the 6th hour, however, the need of intra operative opioids in PCA group is significant.
CONCLUSION
I
n modified radical mastectomy, PECS block is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, PECS block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and can decrease the need of analgesia intra-operative, however PCA analgesic effect last longer, less invasive technique and easier to be used while PECS block require hand skills and limited to 24 hours analgesia only.