Optimized strategy of anesthesia for modified radical mastectomy: transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia / 中华麻醉学杂志

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 per-formed after implanting laryngeal mask airway in group P+G. Transverse thoracic muscle plane block was performed after performing thoracic nerve block typeⅠandⅡin group T+P+G. Flurbiprofen 50 mg was in-travenously 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 recor-ded. Ramsay sedation score was recorded at 10 min after removal of the laryngeal mask airway. The require-ment 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) , and the incidence of nausea and vomiting was significantly decreased in group T+P+G ( P<0. 05) . Compared with group P+G, the time for removal of the laryngeal mask airway and time of pass-ing flatus were significantly shortened, the consumption of fentanyl was decreased ( P<0. 05) , and no sig-nificant change was found in the requirement for rescue analgesia or incidence of nausea and vomiting in group T+P+G ( 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.