APPLICATION OF THE MODIFIED PECS BLOCKADE DURING RECONSTRUCTIVE AND AESTHETIC SURGERY ON THE MAMMARY GLANDS

Abstract

Existing methods of anesthesia, drugs used in the field of breast plastic surgery have a number of features compared to anesthesia in the practice of general surgery. In particular, techniques of regional blockades, such as interfascial blocks PECS 1 and PECS 2 are taken into account. Their effectiveness in comparison with standard methods of anesthesia for different types of interventions on the breast is subject to further discussion.
 Thus, the article presents the results of efficiency in the implementation of the author's development - a modified PECS-block during reconstructive and aesthetic surgery on the mammary glands.
 Material and methods. During 2018-2020, 58 women (average age 36,8 ± 10,8 years) were included in the prospective study, who underwent low-flow inhalation anesthesia with sevoflurane during surgery, and in the postoperative period were divided into two subgroups: 1) subgroup 1, in whom regional anesthesia according to the author's method used; 2) subgroup 2 with nalbuphine analgesia. At the first visit, clinical and laboratory, instrumental ultrasound examination, completed informed consent cards of patients, as well as long-term observation cards were filled in.
 The method of postoperative analgesia developed by the author's method is, in essence, a combination of PECS 1 and PECS 2 blockades. The anesthetic solution was administered so as to effectively block the intercostal nerves that run along the posterior surface of the chest and extend outward into the parasternal region.
 For statistical analysis of the obtained results we used a package of general statistic data “Statistica for Windows” version 6.0 (Stat Soft inc., USA). At p<0, 05, the difference was considered statistically significant.
 Results. It was found that the use of modified PECS-block was characterized by a shortening of the verticalization time by 58,8%, compared with the introduction of nalbuphine and 2,16 times in the absence of postoperative anesthesia. The absolute efficiency (AE,%) of the modified PECS-block relative to the verticalization time was 68,0% higher compared to the use of nalbuphine, with a probable relative efficiency (RR, p<0,05) and the odds ratio (OR, p<0,05). 3 hours after the intervention of AE modified PECS-block relative to the intensity of pain less than 1 point was 89,0%, with a clinical efficiency of 60,0% relative to the use of nalbuphine, probable RR (p<0,05) and OR (p<0,05). The majority of patients who underwent modified PECS-block rated their physical and motor activity by more than 2 points (86,0%), while using nalbuphine the part was only 43.0% (p<0,05). The reversal, moderate regression relationship between pain self-esteem and physical activity (r=-0.46, p<0.05) persisted for 3 hours after the intervention.
 Against the background of the modified PECS block, there was no cases of postoperative nausea, in contrast to nalbuphine (AE – 18,0%, RR – 0,02 [0,003-0,97], p<0,05; HS – 0,02 [0,004-0,87], p<0,05). Regarding the parameters of cardio hemodynamics, it was found that against the background of nalbuphine there was an increase in heart rate to 29,3% after 1 hour, by 48,6 and 39,7% after 3 and 8 hours, compared with the modified PECS-block. The tendency to high (greater than 140 mm Hg) and high normal (greater than 130 mm Hg) blood pressure on the background of nalbuphine, in contrast to the modified PECS-block, where the CAT values during the 1st day stayed in the range of optimal pressure (110-130 mm Hg).