Modifiying efficacy of pectoral nerve block combined with general anesthesia in patients undergoing radical mastectomy

Abstract

Objective To evaluate the modifiying efficacy of pectoral nerve (Pecs) block combined with general anesthesia in patients undergoing radical mastectomy. Methods A total of 60 American Society of Anesthesiologists physical status Ⅰ or Ⅱ female patients, aged 40-64 yr, weighing 50-70 kg, scheduled for elective radical mastectomy, were divided into 2 groups (n= 30 each) using a random number table method: general anesthesia group (group GA) and Pecs block combined with general anesthesia group (group PB+ GA). The patients in group PB+ GA received Pecs block guided by ultrasound.After the needle was advanced to the pleura plane between the pectoralis major and minor, 0.33% ropivacaine 15 ml was injected, and 0.33% ropivacaine 30 ml was injected into the surface of the serratus anterior muscle at the level of the third rib.Anesthesia was induced by intravenous injection of midazolam, propofol, sufentanil and cisatracurium and maintained by target-controlled infusion of propofol and intermittent intravenous boluses of sufentanil and cisatracurium.Bispectral index value was maintained at 40-60.Patient-controlled intravenous analgesia was performed with sufentanil at the end of surgery.Immediately after anesthesia induction, at 30 min and 2 h after skin incision, and at 2, 6 and 24 h after operation, peripheral venous blood samples were collected for determination of the concentrations of plasma epinephrine by radioimmunoassay, and the blood samples were collected from the end of the finger at the same time for determination of blood glucose concentrations.The consumption of intraoperative sufentanil, emergence time, pressing times of patient-controlled analgesia (PCA) and development of nausea and vomiting within 24 h after operation were recorded. Results Compared with group GA, blood glucose and plasma epinephrine concentrations were significantly decreased, the intraoperative sufentanil consumption was reduced, the emergence time was shortened, the pressing times of PCA were decreased at 2, 6 and 24 h after operation(P 0.05). Conclusion When Pecs block combined with general anesthesia is used in the patients undergoing radical mastectomy, it is helpful in reducing the opioid consumption and more helpful in inhibiting postoperative stress responses and pain responses than general anesthesia alone. Key words: Nerve block; Thoracic nerves; Anesthesia, general; Breast neoplasms