الفهرس 
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Abstract
Breast cancer is the most common malignancy in women, and its incidence continues to increase. Surgery is one of the mainstays of treatment of breast cancer, and Modified Radical Mastectomy (MRM) is one of the standard treatments for multi-centric disease or tumors with extensive coexistent ductal carcinoma in situ, where achieving a clear surgical margin becomes difficult with a segmental mastectomy.
The growing increase in the number of breast surgeries as therapy for breast cancer and cosmetic purposes has resulted in an increased need for anaesthetic techniques with improved pain reduction, safety, and fewer complications.
The standard technique in modified radical mastectomy was general anaesthia and giving opioids for pain relief in the postoperative sittings.
In breast surgery, acute postoperative pain from injured muscles and nerves is a consistent risk factor for chronic pain in association with its severity. Postoperative pain can seriously reduce the life quality.
Serratus anterior plane (SAP) block is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve.
Thoracic Erector spinae block is a new procedure that is relatively easier to perform and safer, compared with other modalities.
This Study compared between Serratus Anterior Plane block and Thoracic Erector spinae block as efficacy of postoperative analgesia in Modified Radical Mastectomy.
This was a prospective controlled double blinded randomized clinical study that was conducted at Ain Shams University hospitals, Cairo, Egypt on Adult female patients undergoing modified radical mastectomy and were randomly assigned into two equal groups by computer generated method: group A (control group): patients received general anaesthesia followed by Serratus Anterior plane block using only 20 ml 0.25% Bupivacaine (safety dose 3mg /kg)
group B(study group) : patients received general anaesthesia followed by Thoracic Erector Spinae block using only 20ml bupivacaine 0.25 %. (safety dose 3mg /kg).
This study was comparing between the two groups regarding incidence of postoperative nausea and vomiting , HR , MAP and postoperative VAS score.
The results of our present study can be summarized as follows:
• According to the current study, there were no demographic differences that were statistically significant between the two groups that were being compared. This demonstrated that the two groups were equivalent and that the factors did not affect the study’s overall findings.
• According to hemodynamic measures, neither the intra-operative nor postoperative hemodynamics (heart rate and mean blood pressure) of the two groups were significantly different from one another.
• In the current study, we found that the duration of analgesia was significantly prolonged in group SAP compared to group TES.
• In the current study, we found that the total dose of fentanyl administered intraoperatively were comparable in both groups.
• In the context of the postoperative pain, the current study demonstrated that; VAS was significantly decreased in SAPB group when compared to ESPB group at 2h 1 (0-2) vs 2 (1-3), 4h 2 (1-2) vs 3 (2-3), 6h 3 (1-3) vs 4 (2-4), 12h 4 (2-4) vs 5 (3-6), 18h postoperative 2 (2-3) vs 3 (2-3) with a highly statically significant differences (P<0.001).
• In this study, we found that the postoperative VAS scores were better in group SAP at 2nd, 4th, 6th and 12th hr as compared to group TES.
• The incidence of PONV and the requirement of Ondansetron were found to be similar in both groups.
• None of the patients in either group developed technique-related complications like hemodynamic instability, intravascular injection, pneumothorax, local anaesthetic systemic toxicity, and adverse effects like pruritus and respiratory depression.