Hany Mohamed Mohamed ElZahaby
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Sahar Mohamed Talaat
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Mohamed Mohamed Abd El FattahGhoneim
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Manar Mohsen Ahmed Matared
Abstract
Background
Poorly controlled acute pain after breast surgery is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, prolonged hospital stay and increased likelihood of chronic pain. The analgesic regimen used for postoperative pain control needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient.
Objective
The aim of this study is to compare the intra-operative and the post-operative analgesic effects of the thoracic interfascial plane blocks (serratus anterior plane block in combination with pecto-intercostal fascial plane block) and pectoral nerve blocks (PECS I and II)in patients undergoing non-reconstructive breast surgeries.
Patients and Methods
The study was conducted on 50 randomly chosen patients in Ain Shams University General Surgery Hospital after approval of the medical ethical committee. They were allocated in two groups of 25 patients each. The two groups were compared regarding analgesic outcome by using the visual analogue scaling system in the first 24 hours postoperative and the patients' satisfaction using verbal rating scale and this was the primary outcome of our study. The amount of fentanyl consumed intra-operative, time for first call for rescue analgesia and the frequency of using it were recorded and compared to achieve the secondary outcome of the study which included reducing opiods requirements and avoiding their side effects.
Results
The study found that the total amount of intra-operative fentanyl consumption was significantly higher in the SAPB and PIFB group than the Pecs group with the range of 100-150 versus 100-200 micg fentanyl respectively, and the VAS was significantly higher in the combination of serratus anterior plane block and pecto-intercostal fascial plane block compared to Pecs I and II at 8th, 12th and 24th hours post operatively with p value 0.018, 0.022 and 0.032 respectively, also the frequency of administration of rescue analgesia was higher in the SABP and PIFB group with the range of (2 to 3) times in PECS I and II group versus (2 to 5) in SABP/PIFB group. Besides, the first request of post-operative morphine was significantly delayed in the pectoral nerve blocks than the SABP and PIFB group with the p value (0.020).
Conclusion
The present study found that Pecs I and II group provided superior intra-operative and post-operative analgesic control compared to the serratus and PIFB group in patients undergoing non-reconstructive breast surgeries.
The Tissue Plane