A comparative study to assess the efficacy of dexmedetomidine as an adjuvant to bupivacaine in the ultrasound-guided pectoral and serratus plane nerve block for patients undergoing modified radical mastectomy

2021 ◽  
Vol 15 (3) ◽  
pp. 77
Author(s):  
EnasW Mahdy ◽  
AhmedH.Abd Elrahman ◽  
ElsayedM Abdelzaam
Keyword(s):  
Comparative Study ◽  
Nerve Block ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided

Efficacy of combined ultrasound guided Pectoral Nerve Block (PECS I block and PECS II block) using Bupivacaine with or without Magnesium Sulfate in modified radical mastectomy under general anathesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Salwa Omar El-Khattab ◽  
Mohamed Osman Taeimah ◽  
Mahmoud Mohamed Elsayed Seif
Keyword(s):  
General Anesthesia ◽  
Magnesium Sulfate ◽  
Nerve Block ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Recording Time ◽  
Female Population ◽  
Pectoral Nerve ◽  
Group I

Abstract Background Breast cancer has continued to be the most common cancer afflicting women, accounting for 31% of all new cancer cases in the female population. Every year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for early-stage breast cancers. Objective To evaluate the Efficacy of combined ultrasound guided Pectoral Nerve Block (PECS I block and PECS II block) using Bupivacaine with or without Magnesium Sulfate in modified radical mastectomy under general anathesia. Patients and Methods 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 Thirty Female patients undergoing Modified Radical Mastectomy were divided randomly into two groups, each group consisted of 25 patients group I in which patients received general anesthesia followed by PECS BLOCK using only bupivacaine 0.25 % and group II in which patients received general anesthesia followed by PECS BLOCK using bupivacaine 0.25 % plus magnesium sulfate 50% (200mg). Results 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. Conclusion The addition of 200 mg of magnesium sulfate to bupivacaine in an ultrasound-guided Pectoral Nerve Block significantly reduce postoperative opioid consumption, prolong the duration of the analgesia, and reduce the VAS score without significant side effects after Modified Radical Mastectomy under general anesthesia.

scholarly journals Ultrasound-Guided Transversus Thoracic Muscle Plane-Pectoral Nerve Block for Postoperative Analgesia After Modified Radical Mastectomy: A Comparison with the Thoracic Paravertebral Nerve Block

2021 ◽  
Author(s):  
Ying Zhao ◽  
Weilin Jin ◽  
Peng Pan ◽  
Shuquan Feng ◽  
Danyun Fu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Response ◽  
Nerve Block ◽  
Postoperative Analgesia ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Flurbiprofen Axetil ◽  
Pectoral Nerve ◽  
Fentanyl Consumption

Abstract Background: Modified radical mastectomy (MRM) is a most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain even last for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM.Methods: In this randomized controlled pilot trial, eighty female breast cancer patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n=40) or TPVB (TPVB group, n=40). The primary outcome was 24 h postoperative fentanyl consumption. Secondary outcome measures included intraoperative fentanyl and postoperative flurbiprofen axetil consumption, duration of analgesia, pain intensity at rest and during activity, inflammatory response, and the quality of recovery 40 (QoR-40) score.Results: Intraoperative fentanyl requirement was similar between the two groups; Postoperative fentanyl consumption was decreased in the TTP-PECS group copmared with the TPVB group, as well as the rate of postoperative flurbiprofen axetil consumption, but the duration of analgesia was longer; Pain scores at rest and during activity were dramatically decreased at postoperative 12 h; Moreover, the levels of IL-6, MCP-1 and TNF-α, as well as the levels of PGE2, NPY and β-endorphins were decreased at 12 h after surgery; Finally, the total QoR-40 score, especially for the scores of pain, emotional state and patient support were increased.Conclusion: Both TTP-PECS and TPVB are effective for analgesia after MRM. However, TTP-PECS reduced postoperative fentanyl and flurbiprofen axetil consumption in the first 24 h after MRM, and prolonged the duration of analgesia. Furthermore, TTP-PECS reduced postoperative pain intensity at rest and during activity, and inflammatory response at 12 h postoperation. Finally, TTP-PECS improved QoR-40 scores on the postoperative day. Thus, TTP-PECS is an attractive alternative to TPVB for postoperative analgesia after MRM.

scholarly journals EFFECTIVENESS OF ULTRASOUND-GUIDED MODIFIED PECTORAL NERVE BLOCK (PECS II) FOR POST-OPERATIVE PAIN RELIEF AFTER MODIFIED RADICAL MASTECTOMY (MRM)

2021 ◽  
Vol 71 (3) ◽  
pp. 1011-14
Author(s):  
Azmat Riaz ◽  
Mudasir Saleem ◽  
Khalid Mahmood ◽  
Kaukab Majeed ◽  
Zaki Hussain ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Nerve Block ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Radical Mastectomy ◽  
Control Group ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Pectoral Nerve ◽  
Numerical Rating

Objective: To find the effectiveness of ultrasound guided modified pectoral nerve block (PECS II) versus conventional analgesics for post-operative pain relief in women undergoing modified radical mastectomy. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anaesthesia, Pak Emirates Military Hospital Rawalpindi Pakistan, from May 2018 to Oct 2019. Methodology: A total of 74 adult female patients scheduled for elective unilateral modified radical mastectomy under general anaesthesia were randomized into two groups, pectoral nerve block II (P) group (n=37) and control (C) group (n=37). An ultrasound-guided pectoral nerve block II block was performed using 30 ml of 0.25% Bupivacaine in pectoral nerve block II group after induction of general anaesthesia. In control group (C), patients received only general anaesthesia. Primary outcome measure was opioid consumption in first 24 hours, and the secondary outcome was pain at the breast and axillary region measured using the numerical rating scale (NRS) in first 24 hours at fixed intervals after surgery. Patient satisfaction was evaluated upon discharge using a 4-point scale. Results: Nalbuphine consumption was significantly reduced in pectoral nerve block group as compared to control group. Patients in pectoral nerve block II group experienced much less pain because their numerical rating scale was lower than the control group in postoperative period. Patient satisfaction was found to be high in pectoral nerve block II group. Conclusion: The pectoral nerve block II block is a simple block which provides excellent analgesia for modified radical mastectomy. It can be used for balanced anaesthesia.......

scholarly journals Efficacy and Safety of Ketamine Added to Local Anesthetic in Modified Pectoral Block for Management of Postoperative Pain in Patients Undergoing Modified Radical Mastectomy

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. 485-494
Author(s):  
Fatma Adel El Sherif
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Postoperative Pain ◽  
Nerve Block ◽  
Radical Mastectomy ◽  
Morphine Consumption ◽  
Efficacy And Safety ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Significant Difference

Background: Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. Objectives: This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. Study Design: A randomized, double-blind, prospective study. Setting: Academic medical center. Methods: This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 – 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). Patients were followed up for 48 hours postoperatively for vital signs, VAS score, first request of rescue analgesia and total morphine consumption, sedation score, and side effects. Results: Ketamine plus bupivacaine in Pecs block compared to bupivacaine alone prolonged the mean time of first request of analgesia (18.25 ± 1.98), (12.56 ± 2.64), respectively (P < 0.001), reduced total morphine consumption (12.50 ± 4.63), (18.86 ± 6.28), respectively (P = 0.016). With no significant difference in hemodynamics, respiratory rate, oxygen saturation, VAS and sedation scores, and side effects observed between the 2 groups (P > 0.05). Limitations: This study is limited by its sample size. Conclusion: The addition of ketamine to modified Pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients who underwent a modified radical mastectomy. Key words: Ketamine, bupivacaine, pecs block, postoperative, pain, breast cancer

Comparative Study between the Effect of Ultrasound Guided Pectoral Nerve Block (PEC 1) versus Serratus Anterior Plane Block (SAPB) For Postoperative Analgesia in Modified Radical Mastectomy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abd El-Rahman Abd El-Megeed ◽  
Alaa Eid Mohamed Hassan ◽  
Tarek Mohamed Ahmed Ashour ◽  
Ahmed Mounir Ahmed Youssef
Keyword(s):  
Nerve Block ◽  
Postoperative Analgesia ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Female Population ◽  
Pectoral Nerve ◽  
Group I ◽  
Anterior Plane

Abstract Background Breast cancer has continued to be the most common cancer afflicting women, accounting for 31% of all new cancer cases in the female population. Every year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for earlystage breast cancers. Objectives The aim of this work is to evaluate the Effectiveness of Ultrasound Guided Pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in Modified Radical Mastectomy Patients and Methods 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 Thirty Female patients undergoing Modified Radical Mastectomy were divided randomly into two groups, each group consisted of 15 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB). Results 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. Conclusion SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after Modified Radical Mastectomy under general anesthesia, compared to PEC 1 block.

scholarly journals Ultrasound guided erector Spinae plane block versus modified pectoral plane block in modified radical mastectomy: a prospective, randomized, single blinded study

2021 ◽  
Vol 9 (10) ◽  
pp. 2988
Author(s):  
Upasana Majumdar ◽  
Arun Deka ◽  
Jili Basing ◽  
Rajib Paul
Keyword(s):  
Nerve Block ◽  
Surgical Stress ◽  
Radical Mastectomy ◽  
Erector Spinae ◽  
Effective Control ◽  
General Anesthetics ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Analgesic Consumption

Background: Modified radical mastectomy (MRM) is the most common surgery for cancer breast that is associated with marked postoperative pain. Effective control of this pain suppresses the surgical stress response and decreases the need for opioids and general anesthetics. This study was aimed to compare ultrasound guided erector spinae block (US-ESP) with modified pectoralis nerve block (US-PECS) in terms of post-operative pain scores as the primary objective, in patients undergoing MRM. The secondary objectives of our study were to compare the time of first rescue analgesic, total analgesic consumption and side-effects between the two groups.Methods: Group E comprised of patients receiving 20 mL of 0.2% ropivacaine plus 0.5 µ/kg dexmedetomidine and it was injected in‑between erector spinae muscle and transverse process. Group P comprised of patients receiving 30 mL of 0.2% ropivacaine plus 0.5 µg/kg dexmedetomidine divided into 10 mL that was injected between the two pectoralis muscles in the inter-fascial plane and the remaining 20 mL was injected between the serratus anterior and the pectoralis minor muscle.Results: Demographic profile was comparable between both groups. Both groups offered good analgesia, but PECS group took an upper hand up to the 6th post-operative hour (p<0.05). Beyond the 6th post-operative hour, analgesic efficacy of both groups was comparableConclusions: Modified pectoralis nerve block offered better analgesia over the erector spinae block technique up to 6th post-operative hour and it is more effective in terms of total rescue analgesic consumption and the time for request of first rescue analgesic, in patients posted for MRM.

Sign in / Sign up

Export Citation Format

Share Document