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 (Arsalani-Zadeh et al., 2011).
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 (Andersen and Kehlet, 2011).
However, Traditional opioid-based analgesia remains the mainstay, different techniques including regional local anaesthetic infiltrations, paravertebral and neuraxial analgesia, anti-neuropathic analgesics and NMDA antagonists have all been used either in isolation or in combination.
After the application of ultrasound in anesthetic practice, several interfascial plane blocks have been described recently. Pec 1 block involves a hydro dissection of the plane between the pectoral muscles with local anaesthetic to block the lateral and medial pectoral nerves. Serratus anterior plane blocks performed at the axillary fossa, the intercostobrachialis nerve, lateral cutaneous branches of the intercostal nerves (T3–T9), long thoracic nerve, and thoracodorsal nerve are located in a compartment between the serratus anterior and the latissimus dorsi muscles, between the posterior and midaxillary lines. Those are newer US-guided blocks for analgesia after breast and lateral thoracic wall surgery. The key sonographic landmarks are the pectoralis major, pectoralis minor, and serratus anterior muscles and the pectoral branch of the acromiothoracic artery.
The aim of this work is to evaluate the analgesic efficiency and safety of pectoral nerve block by adding magnesium sulphate to bupivacaine as an adjuvant versus bupivacaine as a sole agent in cases of modified radical mastectomy (MRM).
After obtaining approval from the medical ethical committee in Ain Shams University This study was conducted in the operating theatres of Ain Shams University Hospitals. It included twenty four Female patients undergoing Modified Radical Mastectomy were divided randomly into two groups, each group consisted of 12 patients group A in which patients received general anesthesia followed by PECS BLOCK using only bupivacaine 0.25 % and group B in which patients received general anesthesia followed by PECS BLOCK using bupivacaine 0.25 % plus magnesium sulfate 50% (300mg).
The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed.
In our study we found Pectoral Nerve Block using only bupivacaine reduce postoperative opioid consumption. And the addition of 300 mg of magnesium sulfate to bupivacaine in an ultrasound-guided Pectoral Nerve Block significantly prolong the duration of the analgesia, and reduce the VAS score without significant side effects after Modified Radical Mastectomy under general anesthesia.