الفهرس 
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Abstract
Effective pain management helps to reduce postoperative complications and leads to early mobilization and faster recovery, there by increasing patient satisfaction and decreasing the cost of care. Analgesia in breast surgeries can be delivered orally, intravenously, intramuscularly, neuroaxial or via regional nerve blocks.
Intravenous opioids are mainly administered for acute post operative mastectomy pain but it leads to developmentof many side effects such as sedation, nausea, vomiting and respiratory depression. Thoracic epidural analgesia and paravertebral block become the gold standard techniques for breast surgery but they are associated with serious complications such as pneumothorax and total spinal anesthesia.
Pecs blocks in breast surgeries performed under ultrasound guidance are a viable alternative to other more invasive regional anesthetic techniques which carry an increased side effect.
The aim of this study was to evaluate the efficacy of ultrasound guided Pectoral neves block for post operative analgesia in modified radical mastectomy surgery.
After the approval of the ethical committee of Sohage Cancer Center and provided written informed consent from patients, the present study was carried out on fourty adult female patients who admitted to the Sohage Cancer Center for elective modified radical mastectomy. All patients included in the present study were grade I or II of physical status American Society of Anesthesiologists (ASA). All patients trained to use visual analogue scale to express their pain. All patients arrived to the block room 30 minutes before the operation. The blocks were done after insertion of 20 G peripheral venous catheter and attached to the multichannel monitor for each patient.
Patients were randomly assigned into two groups (20 each):
1- Pecs block group: they received preoperative Pecs blocks followed by general anesthesia. The patient lied in supine position and a high frequency linear probe (10 MHz) was covered with sterile sheath and used for the scanning after disinfection of the skin. After careful intermittent aspiration to avoid intravascular injection a 10ml of bupivacaine 0.25 % with adrenaline 1:200000 (5ug/ml) was injected between two pectoral muscles (the inter-pectoral plane) below the lateral half of the clavicle as Pecs I,and 20 ml of bupivacaine 0.25 % with adrenaline 1:200000 (5ug/ml) was injected between pectoralis minor and serratus anterior at the level of 3rd rib or 4th rib below the lateral third of the clavicle as Pecs II.
2- Control group: They receive general anesthesia only
The following results were obtained:
There were a significant difference in the intra and post-operative heart rate (beats/min) and intra and post-operative mean arterial blood pressure (mmHg) without hypotension or bradycardia in Pecs group with P value < 0.05.
Regarding the number of patients consumed intraoperative fentanyl there was a significant difference between both groups, it was higher in control than Pecs group with the Pecs group with a mean 66.66 ± 38.99 mic. fentanyl in control group vs 31 ± 25 mic. fentanyl in Pecs group (P-value = 0.001) and the total number of patients needed fentanyl in the control group was 18 vs 9 in the Pecs group (P value = 0.001).
It found that VAS was significant higher in control group than Pecs group form arrival to PACU till the 16th hours post operatively.
When comparing the results of both groups in the number of patients received postoperative nalbuphine, there was significant increase in the number of patients in control group than Pecs group the total number of patients needed nalbuphine in the control group was 16 vs 7 in the Pecs group (P value = 0.001). There was a significant difference concerning the total dose of nalbuphine consumption in 24 hours postoperative between both groups with the Pecs group with a mean 9.5 ± 6.46 mg nalbuphine in control group vs 3.25 ± 4.94 mg nalbuphine in Pecs group (P-value = 0.001)
There was a higher satisfaction scores were obtained in Pecs group than in conterl group with no detected complications other than PONV.