ABSTRACT
Among the various surgical procedures, breast surgeries rank as a frequently conducted procedure. Interfacial blocks such as the Pectoral (PECS) block became possible with the currently available knowledge on innervations and ultrasound. Interfacial blocks target the deep fascial planes, which are potential spaces for injecting local anesthetics. The Pectoral I (PECS I) consists of the injection of local anesthetics in the plane between the pectoralis major and minor muscles. The PECS II block, a modified version of the block, is achieved by adding another, deeper injection in the plane between the pectoralis minor and the serratus anterior muscle. We conducted a scoping review using Arkesy and O'Malley's framework, as described by Levac. We identified our research question as the uses of the PECS regional block technique with the choice of local anesthetics, including adjuncts, and its effectiveness in intraoperative and postoperative analgesia in the first 24 hours and incidence of postoperative nausea and vomiting. Subsequently, we identified the relevant studies that met our inclusion criteria and charted the data. Lastly, we summarized and reported the results. The PECS block was used in various breast surgeries, among which radical mastectomies with/without lymph node dissection were the most common. It was found that the PECS block reduced intraoperative opioid consumption in 60% and 24-hour postoperative opioid consumption in 93.3% of the included papers. Various local anesthetics were used such as ropivacaine, bupivacaine, and levobupivacaine. Ultrasound-guided interfacial plane blocks, such as the PECS block, are a recent development in regional anesthesia that offers analgesia for patients undergoing breast surgeries. The authors conclude that PECS block can provide a decrease in intraoperative and postoperative opioid consumption, a decrease in the incidence of nausea and vomiting, and can lead to overall patient satisfaction in terms of lower pain scores compared to systemic analgesia.
ABSTRACT
Objective The purpose of this study is to measure the prevalence of premenstrual syndrome (PMS), its management, and its possible association with depression, anxiety, and stress among female medical and non-medical students. Methods A cross-sectional study was conducted at King Khalid University Hospital and King Saud University Female Campus. A self-administered questionnaire following the American College of Obstetricians and Gynecologists (ACOG) criteria was used to measure levels of PMS. It also included the Depression Anxiety Stress Scale (DASS) to measure depression, anxiety, and stress. The inclusion criteria were: females of reproductive age who had menstrual cycles for two consecutive months. Meanwhile, the exclusion criteria included gynecological or psychological problems, pregnancy, and the use of oral contraceptive pills. Of the 513 responses, 414 met the above criteria and were used in the study. An analysis was done using the Statistical Package for the Social Sciences (SPSS, version. 21.0, IBM Armonk, NY). To compare the mean values of quantitative variables, the student's t-test for independent samples was used. Accordingly, Pearson's correlation quantified the linear relationship between the two quantitative variables. Results The majority of female students have a moderate level of PMS, and only 8% have severe PMS. Notably, 8.9% of the students have moderate anxiety while 1.7% and 0.7% have severe and extremely severe anxiety, respectively. Moreover, 11.8% and 3.4% of the students have moderate depression and stress, respectively, whereas 1.7% have severe depression. The results show a positive correlation between PMS and anxiety, depression, and stress. Depression and stress scores vary significantly between medical and non-medical students. Conclusion Premenstrual syndrome is a prevalent issue among females, and it can negatively affect their health. There is a need to study PMS thoroughly to optimize and guide its management for further improving women's health.
