Abstract
Background Modified radical mastectomy (MRM) has a large incision range and can cause strong intraoperative stress, a high incidence of postoperative acute pain, and chronic pain. There are few studies on the objective evaluation of the perioperative stress response by some stress-related serological indicators and on the long-term follow-up evaluation of postoperative quality of life and the incidence of chronic pain. This study aimed to evaluate the efficacy of ultrasound guided type Ⅰ Pecs block (Pecs Ⅰ), type Ⅱ Pecs block (Pecs Ⅱ) and transverse thoracic muscle plane block (TTP) on reducing CRP, IL-6, and WBC values during surgery and on enhancing World Health Organization on Quality of Life Brief Scale (QOL) scores 6 months after MRM.Methods The randomized, placebo-controlled and double-blind study was conducted in 76 patients assigned to two groups that received either ultrasound guided Pec Ⅰ + Pec Ⅱ +TTP block with 40 ml of 0.25% ropivacaine (group PT) or saline (group C). The primary outcomes were the changes in CRP, IL-6 and WBC values on the first day before surgery and the first and third days after surgery, the changes in blood glucose levels before and after surgery, and the QOL scores evaluated 6 months after surgery.Results The median (IQR) CRP, IL-6, and WBC values were significantly reduced in group PT on the first day compared with those in group C (12 (10-13.25) mg/l, 10.45 (9.575-11.65) pg/ml, 9 (7.75-9.25)×109/ l, vs 24 (20.75-26.25) mg/l, 25.35 (19.3-29.675) pg/ml, 12 (11-13) ×109/l, respectively, p< 0.001). The median (IQR) QOL was significantly higher in group PT 6 months after surgery than in group C (53(51.75-55) vs 43 (41-51.5), p< 0.001). The incidence of chronic pain was significantly lower, n/all was 4/33 vs 0/34, p< 0.001. Conclusions Ultrasound guided Pecs I, II and TTP block, significantly reduced the CRP, IL-6 and WBC values on the first day; increased the QOL scores and the incidence of chronic pain 6 months after surgery; and promoted the rapid recovery of patients.Trial registration: chictr.org.cn ChiCTR2000033275. Registered on 26 May 2020
Comparison of Oral Amoxicillin with Placebo for the Treatment of World Health Organization-Defined Nonsevere Pneumonia in Children Aged 2-59 Months: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial in Pakistan
