Abstract
Finding the best analgesic technique for breast surgeries has always been a matter of great concern. Stable intraoperative hemodynamics and comfortable postoperative patient is what every anesthesiologist aspire of. The benefits of using regional blocks for postoperative analgesia is well known. Hence we intended to study the analgesic efficacy of two of the most latest blocks, used for breast surgeries, the PECS block and the ESP block. The prospective open label study was conducted in 59 ASA 1, 2 patients, planned for Modified Radical Mastectomy(MRM) under general anesthesia. After approval from institution scientific and research committee, and obtaining written informed consent, the patients were randomly divided into two groups(P and E). Group P(N=30), received ultrasound guided modified PEC block with 30ml of 0.25% levobupivacaine. Group E(N=29) received ultrasound guided ESP block with 30 ml of 0.25% levobupivacaine. General anesthesia was then administered in both the groups. The intraoperative hemodynamics, duration of analgesia, VAS score, number of rescue analgesia, patients satisfaction, safety and side effects were noted and compared between the two groups. The mean VAS score at 24 hours was 4.11 ± 0.629 in group P and the mean VAS score at 24 hours post operatively was 3.69 ± 0.679 in group E, and the difference was statistically significant (P=0.024). Both PECS and ESP block can be used efficaciously for providing analgesia for MRM surgeries, with ESP block providing longer duration of pain free postoperative period, without any noted side effects and technical difficulties.
Highlights
Finding the best analgesic technique for breast surgeries has always been a matter of great concern
31% of the breast surgeries performed is Modified Radical Mastectomy (MRM). 4 MRM is commonly performed under general anesthesia, and is very often associated with postoperative pain, nausea and vomiting, causing increased patient suffering
Seen to be 70-80.9% on first postoperative day, and 53%, 33% on the second and third postoperative day respectively. 5,6 The presence of acute postoperative pain leads to the development of chronic post mastectomy pain syndrome
Summary
Finding the best analgesic technique for breast surgeries has always been a matter of great concern. Materials and Methods: The prospective open label study was conducted in 59 ASA 1, 2 patients, planned for Modified Radical Mastectomy(MRM) under general anesthesia. Group P(N=30), received ultrasound guided modified PEC block with 30ml of 0.25% levobupivacaine. Conclusion: Both PECS and ESP block can be used efficaciously for providing analgesia for MRM surgeries, with ESP block providing longer duration of pain free postoperative period, without any noted side effects and technical difficulties. 3. 31% of the breast surgeries performed is Modified Radical Mastectomy (MRM). 4 MRM is commonly performed under general anesthesia, and is very often associated with postoperative pain, nausea and vomiting, causing increased patient suffering. 5,6 The presence of acute postoperative pain leads to the development of chronic post mastectomy pain syndrome. Pathania and Khanoria / Indian Journal of Clinical Anaesthesia 2020;7(3):[496–501] duration of post anesthesia care unit stay.[8,9] Regional anesthesia may reduce cancer progression by attenuation of the surgical stress response, and by direct protective action of local anesthetics on cancer cell migration. 10
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