PDF(Pubmed)
Abstract：
Multidisciplinary treatment and multimodal analgesia are the approach to reduce mortality and morbidity of breast cancer. Pectoral nerve block (PECS I and II) is one of the modes of analgesia advocated. The primary aim is to find the risks and benefits of the block in providing analgesia for intraoperative and immediate postoperative cancer-related breast surgery and total morphine consumption. The secondary aim is to evaluate, any additional knowledge acquired, in the reduction of persistent chronic pain state and cancer recurrence, during the time frame studied. The study was conducted after the approval of the ethics committee and National Registry, and included patients of ASA I and II undergoing mastectomy surgery with axillary clearance, under general anesthesia, during the period of 2017 to 2018. A total of 60 patients were recruited, randomizing them into two groups: group 1 (n = 30): ultrasound-guided PECS I (0.2 ml/kg) and PECS II (0.4 ml/kg) block, post-induction with 0.25% levobupivacaine, maximum dose of 2 mg/kg; group 2 (n = 30): no block, only general anesthesia. Intraoperatively, vitals were monitored at regular intervals and analgesics given as per response. Postoperatively, pain was assessed using the numerical pain score and arm abduction score, until discharge. Data collected was analyzed and interpreted using statistical methods. Patients were followed up telephonically, until six months for any chronic pain and cancer recurrence instances. The PECS block group used less morphine intra and postoperatively, which was statistically significant (p = 0.0001). Group 1- Had a significant decrease in the mean intraoperative systolic blood pressure (p = 0.03). There was significant improvement in the arm abduction in the test group as compared to that in the control group (p = 0.001). The average time for block performance was 7.9 min and no complications were observed. No patients in the study groups reported chronic pain or cancer recurrence issues. The two-level PECS block is safe, effective, reliable, and easy to perform. Clinical Trial Registration Number: CTRI/2017/11/010630.
摘要：
多学科治疗和多模式镇痛是降低乳腺癌死亡率和发病率的方法。胸神经阻滞（PECSI和II）是提倡的镇痛方式之一。主要目的是发现阻滞术中和术后立即与癌症相关的乳房手术和总吗啡消耗提供镇痛的风险和益处。次要目的是评估，获得的任何额外知识，在减少持续的慢性疼痛状态和癌症复发，在研究的时间范围内。这项研究是在伦理委员会和国家登记处批准后进行的。并包括ASAI和II接受腋窝间隙乳房切除术的患者，在全身麻醉下，2017年至2018年期间。共招募了60名患者，将它们随机分为两组：第1组（n=30）：超声引导的PECSI（0.2ml/kg）和PECSII（0.4ml/kg）阻滞，用0.25%左布比卡因诱导后，最大剂量为2mg/kg；第2组（n=30）：无阻滞，只有全身麻醉。术中,定期监测生命体征,并根据反应给予镇痛药.术后,使用数字疼痛评分和手臂外展评分评估疼痛，直到出院。使用统计方法对收集的数据进行分析和解释。病人接受了电话随访，直到六个月任何慢性疼痛和癌症复发的情况。PECS阻滞组在术中和术后使用吗啡较少，具有统计学意义（p=0.0001）。第1组平均术中收缩压明显降低（p=0.03）。与对照组相比，测试组的手臂外展有显着改善（p=0.001）。平均阻滞时间为7.9min，未观察到并发症。研究组中没有患者报告慢性疼痛或癌症复发问题。两级PECS块是安全的，有效,可靠,并且易于执行。临床试验登记号：CTRI/2017/11/010630。
