Optimized strategy of anesthesia for modified radical mastectomy: transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia

Abstract

Objective To evaluate the efficacy of transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia when used for modified radical mastectomy. Methods Sixty female patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 45-63 yr, weighing 48-72 kg, scheduled for elective modified radical mastectomy, were divided into 3 groups (n=20 each) using a random number table method: thoracic nerve block-general anesthesia group (group P+ G), transverse thoracic muscle plane-thoracic nerve block-general anesthesia group (group T+ P+ G) and general anesthesia group (group G). Anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium and maintained with sevoflurane, fentanyl and cisatracurium.Thoracic nerve block typeⅠ and Ⅱ was performed after implanting laryngeal mask airway in group P+ G.Transverse thoracic muscle plane block was performed after performing thoracic nerve block typeⅠ and Ⅱ in group T+ P+ G.Flurbiprofen 50 mg was intravenously injected after operation as a rescue analgesic to maintain the Visual Analogue Scale score≤3.The consumption of opioids, emergence time and time for removal of the laryngeal mask airway were recorded.Ramsay sedation score was recorded at 10 min after removal of the laryngeal mask airway.The requirement for rescue analgesia, time of passing flatus and development of nausea and vomiting within 24 h after operation were recorded. Results Compared with group G, the emergence time, time for removal of the laryngeal mask airway and time of passing flatus were significantly shortened, and the Ramsay sedation score, consumption of fentanyl and requirement for rescue analgesia were decreased in P+ G and T+ P+ G groups (P 0.05). Conclusion Transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia can provide satisfactory perioperative analgesia and is helpful in improving prognosis for the patients undergoing modified radical mastectomy. Key words: Thoracic nerves; Nerve block; Anesthesia, general; Breast neoplasms; Transversus thoracic muscle