PDF(Pubmed)
Abstract：
BACKGROUND: Breast carcinoma is one of the most common cancers in present-day women worldwide, hence surgical intervention for the same is inevitable. General anesthesia being the preferred technique, the selection of appropriate postoperative pain management is a major concern in which superficial fascial plane chest wall blocks play a pivotal role. We aimed to prove the efficacy of peripheral nerve stimulator-guided pectoral nerve-1 (PEC 1) block and serratus anterior plane (SAP) block for postoperative analgesia in modified radical mastectomy.
METHODS: This prospective randomized controlled clinical study comprised 60 females undergoing modified radical mastectomy and was randomly allocated to two groups. Group A patients received general anesthesia while, in addition to general anesthesia, group B patients received PEC 1 and SAP blocks. Postoperatively the active and passive visual analog score (VAS), duration of analgesia, cumulative requirement of rescue analgesics in the first 24 hours and associated perioperative complications were noted. All quantitative data were analyzed by student t-test and qualitative data by chi-square test using MedCalc software 12.5.
RESULTS: VAS score for first 24 hours in group B was lower at rest, on pressure over the surgical site as well as on movements compared with the patients in group A with the p-value being < 0.0001 at all time intervals. Time for receiving first rescue analgesia was shorter (1.25±0.56hour vs 20.05±7.78hour, p<0.001) with the significantly higher requirement of cumulative doses of tramadol in the first 24 hours in patients belonging to group A (233.33±47.95mg vs 110±31.62 mg, p<0.001).
CONCLUSIONS: PEC 1 and SAP blocks given under peripheral nerve stimulator guidance have a high success rate and are reliable in providing adequate postoperative analgesia for patients undergoing modified radical mastectomy.
METHODS: This prospective randomized controlled clinical study comprised 60 females undergoing modified radical mastectomy and was randomly allocated to two groups. Group A patients received general anesthesia while, in addition to general anesthesia, group B patients received PEC 1 and SAP blocks. Postoperatively the active and passive visual analog score (VAS), duration of analgesia, cumulative requirement of rescue analgesics in the first 24 hours and associated perioperative complications were noted. All quantitative data were analyzed by student t-test and qualitative data by chi-square test using MedCalc software 12.5.
RESULTS: VAS score for first 24 hours in group B was lower at rest, on pressure over the surgical site as well as on movements compared with the patients in group A with the p-value being < 0.0001 at all time intervals. Time for receiving first rescue analgesia was shorter (1.25±0.56hour vs 20.05±7.78hour, p<0.001) with the significantly higher requirement of cumulative doses of tramadol in the first 24 hours in patients belonging to group A (233.33±47.95mg vs 110±31.62 mg, p<0.001).
CONCLUSIONS: PEC 1 and SAP blocks given under peripheral nerve stimulator guidance have a high success rate and are reliable in providing adequate postoperative analgesia for patients undergoing modified radical mastectomy.
摘要：
背景：乳腺癌是当今全球女性最常见的癌症之一，因此，同样的手术干预是不可避免的。全身麻醉是首选技术，选择合适的术后疼痛管理是一个主要问题，其中浅筋膜平面胸壁块起着关键作用。我们旨在证明周围神经刺激器引导的胸神经-1（PEC1）阻滞和锯肌前平面（SAP）阻滞在改良根治术中的术后镇痛效果。
方法：这项前瞻性随机对照临床研究包括接受改良根治术的60名女性，随机分为两组。A组患者接受全身麻醉,除了全身麻醉,B组患者接受PEC1和SAP阻滞.术后主动和被动视觉模拟评分（VAS），镇痛持续时间，记录了前24小时内抢救镇痛药的累积需求和相关的围手术期并发症.采用MedCalc软件12.5对所有定量数据进行t检验,定性数据采用卡方检验。
结果：B组前24小时的VAS评分在休息时较低，与所有时间间隔p值<0.0001的A组患者相比，手术部位的压力以及运动。首次抢救镇痛时间较短(1.25±0.56小时vs20.05±7.78小时,p<0.001），在属于A组的患者中，前24小时对曲马多的累积剂量的要求显着提高（233.33±47.95mgvs110±31.62mg，p<0.001)。
结论：外周神经刺激器引导下给予PEC1和SAP阻滞成功率高，能够可靠地为改良根治术患者提供充分的术后镇痛。
方法：这项前瞻性随机对照临床研究包括接受改良根治术的60名女性，随机分为两组。A组患者接受全身麻醉,除了全身麻醉,B组患者接受PEC1和SAP阻滞.术后主动和被动视觉模拟评分（VAS），镇痛持续时间，记录了前24小时内抢救镇痛药的累积需求和相关的围手术期并发症.采用MedCalc软件12.5对所有定量数据进行t检验,定性数据采用卡方检验。
结果：B组前24小时的VAS评分在休息时较低，与所有时间间隔p值<0.0001的A组患者相比，手术部位的压力以及运动。首次抢救镇痛时间较短(1.25±0.56小时vs20.05±7.78小时,p<0.001），在属于A组的患者中，前24小时对曲马多的累积剂量的要求显着提高（233.33±47.95mgvs110±31.62mg，p<0.001)。
结论：外周神经刺激器引导下给予PEC1和SAP阻滞成功率高，能够可靠地为改良根治术患者提供充分的术后镇痛。
