Optimization strategy of anesthesia for modified radical mastectomy for breast cancer: transverse thoracic muscle plane block-pectoral nerve block with compound lidocaine-general anesthesia / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the optimization efficacy of transversus thoracic muscle plane block (TTPB)-pectoral nerve block (PECS) with compound lidocaine-general anesthesia for modified radical mastectomy for breast cancer.Methods:Ninety female patients, aged 40-64 yr, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ and body mass index <30 kg/m 2, undergoing elective modified radical mastectomy for breast cancer, were divided into 3 groups ( n=30 each) using the random number table method: general anesthesia group (group C), TTPB-PECS with compound lidocaine-general anesthesia group (group L), and TTPB-PECS with ropivacaine-general anesthesia group (group R). The laryngeal mask was used for total intravenous anesthesia.PECS I, PECS II and TTPB were performed sequentially after laryngeal mask placement in L and R groups, and 0.4% compound lidocaine 15, 15 and 10 ml (group L) and 0.375% ropivacaine 15, 15 and 10 ml (group R) were injected at the above three points, respectively.Patient-controlled intravenous analgesia (PCIA) was performed with sufentanil at patient-controlled analgesia (PCA) dose of 2 ml/dose and a lockout time of 15 min at the end of operation, and when visual analog scale (VAS) score ≥ 3 points, sufentanil 5 μg was given intravenously for rescue analgesia.The intraoperative consumption of propofol and remifentanil, emergence time, and laryngeal mask removal time were recorded.The Ramsay sedation score and duration of postoperative analgesia were recorded at 10 min after removal of the laryngeal mask.The consumption of sufentanil, ratio of the effective pressing times to the total pressing times of PCA (D 1/D 2 ratio), requirement for rescue analgesia, and occurrence of adverse effects such as nausea and vomiting, skin pruritus, bradycardia, and respiratory depression within 48 h after surgery were recorded. Results:Compared with C group, the intraoperative consumption of propofol and remifentanil was significantly reduced, the emergence time and laryngeal mask removal time were shortened, Ramsay sedation scores was decreased, postoperative VAS scores were decreased, duration of postoperative analgesia was prolonged, D 1/D 2 ratios were increased, the consumption of sufentanil was reduced, and the requirement for rescue analgesia and incidence of postoperative nausea and vomiting were decreased in R and L groups ( P<0.05). Compared with R group, the duration of postoperative analgesia was significantly prolonged, D 1/D 2 ratio was increased, the consumption of sufentanil was decreased, and the requirement for rescue analgesia was decreased in L group ( P<0.05). Conclusions:Compared with general anesthesia, TTPB-PECS with compound lidocaine-general anesthesia used in modified radical mastectomy for breast cancer is helpful in achieving a low-opioid anesthetic mode, which is more conducive to suppressing postoperative hyperalgesia and promoting early postoperative recovery, and the optimization efficacy is more significant than that of ropivacaine.