ABSTRACT
Objective To investigate the efficacy of the single-injection technique of PECS Ⅰ and Ⅱ blocks for postoperative analgesia in patients undergoing modified radical mastectomy. Methods Sixty female patients who would undergo elective unilateral modified radical mastectomy, aged 30-65 years, falling into ASA physical status Ⅰ or Ⅱ, were selected and randomly divided into PECS group (group P) or control group (group C), 30 cases in each. After induction, patients in group P underwent ultrasound-guided combined PECS Ⅰ and Ⅱ blocks in a single-injection technique before surgery, 30 ml of 0.5％ ropivacaine was given to these patients. Patients in group C received general anesthesia alone. Anesthesia maintenance was performed by total intravenous anesthesia. The dosage of intraoperative propofol and remifentanil, postoperative recovery time, the requirement of sufentanil at 48 h after operation and the first time pressing the analgesic pump button, rescue analgesic requirements at 48 h after operation and the pressing frequency of analgesic pump were recorded in the two groups. Results The usage of propofol and remifentanil in group P were significantly less than those in group C (P ＜ 0.05). The recovery time after operation was significantly shorter than that in group C (P ＜ 0.05). The total consumption of sufentanil after 48 h was significantly less than that in group C (P ＜ 0.05). The first pressing time of the analgesic pump in group P was significantly later than that in group C (P ＜ 0.05).The rescue analgesic requirements in group P at 48 h were lower than those in group C (P ＜ 0.05).The pressing frequencies of analgesic pump in group P at 24 h were less than those in group C (P ＜ 0.05). Conclusion For patients undergoing modified radical mastectomy, ultrasound-guided combined PECS Ⅰ and Ⅱ blocks in a single-injection technique can reduce the dosage of opioid drugs in the perioperative period, and can provide better analgesic effect after operation.
ABSTRACT
Objective To evaluate the efficacy and safety of PECS block under ultrasound guidance in multimodal analgesia after modified radical mastectomy.Methods Sixty female patients aged 18-65 years, ASA grade Ⅰ or Ⅱ, undergoing elective unilateral modified radical mastectomy were enrolled.Patients were randomly divided into PECS group (group P, n=30) or control group (group C, n=30).Two groups of patients were given flurbiprofen axetil 1 mg/kg via intravenous injection before operation.After general anesthesia induction, patients in group P received ultrasound guided pectoral nerves block with 30 ml of 0.375% ropivacaine.Patients in group C didn`t receive nerve block.Anesthesia maintenance was performed by combined intravenous-inhalation Anesthesia.Postoperative VAS pain scores (at 0, 3, 6, 12, and 24 postoperative hours), does of intraoperative remifentanil, rescue analgesic requirements in the first 24 h after surgery, adverse reactions were recorded.Results VAS score in group P was lower than that in group C at 0, 3, 6 and 12 h after surgery (P<0.05), there was no difference at 24 h.The dose of remifentanil and the rescue analgesic requirements in group P were lower than those in group C (P<0.05).There was no significant difference in postoperative adverse reactions between the two groups.Conclusion As a supplementary mode of multimodal analgesia, PECS block is a safe and reliable technique that provide better analgesia effect for modified radical mastectomy.
ABSTRACT
Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.
Subject(s)
Female , Humans , Middle Aged , Anesthesia , Anesthesia, Conduction , Anesthesia, General , Breast , Carcinoma, Ductal , Conscious Sedation , Dexmedetomidine , Mastectomy, Segmental , Nerve Block , Pain, PostoperativeABSTRACT
The sternalis muscle (SM) is an anatomical variant found in the anterior thoracic wall. While the attachment sites of SM are generally agreed upon, the innervation and function of this muscle are not well established. Cadaveric and surgical explorations to date report that SM is innervated by either the pectoral nerves or the anterior branches of the intercostal nerves, or a combination of both. Knowledge of SM is relevant to health care providers specialising in imaging and/or surgery of the anterior thoracic wall. This paper aims to raise awareness in the medical community of the clinical relevance of SM through two case reports and a brief literature review.
El músculo esternal (ME) es una variante anatómica en la pared torácica anterior. Mientras que los sitios de fijación del ME estan acordados, la inervación y la función de este músculo no están bien establecida. Exploraciones cadavéricas y quirúrgicas han informado que el ME está inervado por los nervios pectorales o ramos anteriores de los nervios intercostales, o una combinación de ambos. El conocimiento del SE es relevante para los proveedores de atención de salud especializada de imágenes y/o cirugía de la pared torácica anterior. Este documento tiene como objetivo crear conciencia en la comunidad médica de la relevancia clínica de ME a través de dos reportes de caso y una breve revisión bibliográfica.
Subject(s)
Humans , Spinal Dysraphism/diagnosis , Spinal Dysraphism/etiology , Fetus/anatomy & histology , Fetus/innervation , Fetus/ultrastructure , Intercostal Nerves/anatomy & histology , Intercostal Nerves/ultrastructure , Thoracic Nerves/anatomy & histology , Thoracic Nerves/ultrastructureABSTRACT
CONTEXT AND OBJECTIVE: Systematic modifications to the surgical technique of mastectomy have been proposed with the objective of minimizing injuries to the pectoral nerves and their effects. The aim of this study was to compare muscle strength and mass of the pectoralis major muscle (PMM) and abduction and flexion of the homolateral upper limb following mastectomy among women with breast cancer undergoing either preservation or sectioning of the medial pectoral nerve (MPN). DESIGN AND SETTING: Randomized, double-blind, clinical trial on 30 women with breast cancer who underwent mastectomy between July 2002 and May 2003 in Campinas, Brazil. METHODS: The women were allocated to a group, in which the MPN was preserved, or to another group in which it was sectioned. Fisher's exact and Wilcoxon tests were used to analyze the data, along with Friedman and ANOVA analysis of variance. RESULTS: In the MPN preserved group, 81 percent of the women did not lose any PMM strength, compared with 31 percent in the sectioned MPN group (confidence interval, CI = 1.21; relative risk, RR = 2.14; P < 0.03). There were no differences between the groups regarding muscle mass (CI = 0.32; RR = 0.89; P = 0.8), shoulder abduction (CI = 1.36; RR = 0.89; P = 0.28) and shoulder flexion (CI = 1.36; RR = 1.93; P = 0.8). CONCLUSIONS: Preservation of the MPN was significantly associated with maintenance of PMM strength, compared with nerve sectioning. No differences in muscle mass or in abduction and flexion of the homolateral shoulder were found between the groups. CLINICAL TRIAL REGISTRATION NUMBER: ANZCTR - 00082622
CONTEXTO E OBJETIVO: Modificações sistemáticas técnica cirúrgica das mastectomias têm sido propostas com o objetivo de minimizar lesões dos nervos peitorais e seus efeitos. O objetivo deste artigo foi comparar força e trofismo do músculo peitoral maior (MPM) e amplitude de movimento do membro superior, homolaterais à mastectomia em mulheres com carcinoma de mama submetidas à preservação ou não do nervo peitoral medial (NPM). TIPO DE ESTUDO E LOCAL: Ensaio clínico aleatório, duplo-cego, com 30 mulheres com carcinoma de mama submetidas a mastectomias entre julho de 2002 e maio de 2003, em Campinas, Brasil. MÉTODOS: As mulheres foram alocadas em um grupo em que o NPM foi preservado e em outro no qual o NPM foi seccionado. Para análise de dados, foram utilizados os testes exato de Fisher e Wilcoxon, além das análises de variância de Friedman e Anova (análise de variância). RESULTADOS: No grupo com NPM preservado, 81 por cento das mulheres não sofreram perda de força do MPM comparado a 31 por cento no outro grupo (intervalo de confiança, IC = 1.21 e risco relativo, RR = 2.14, P < 0,03). Em relação a trofismo muscular (IC = 0.32 e RR = 0.89, P = 0.8), a abdução (IC = 1.36, RR = 0.89, P = 0.28) e flexão (IC = 1.36, RR = 1.93 e P = 0.8) do ombro homolateral, não houve diferenças entre os grupos. CONCLUSÃO: A preservação do MPM foi significativamente associada a manutenção da força do MPM comparada com a secção do nervo. Não foram encontradas diferenças no trofismo muscular ou na amplitude de movimento do ombro entre os grupos. REGISTRO DE ENSAIO CLÍNICO NÚMERO: ANZCTR - 00082622