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Evaluation of postoperative pain in patients undergoing modified radical mastectomy with pectoralis or serratus-intercostal fascial plane blocks

대한마취과학회지 2020년 73권 5호 p.425 ~ 433
Kaur Ushkiran, Shamshery Chetna, Agarwal Anil, Prakash Neel, Valiveru Ramya Chakrapani, Mishra Prabhaker,
소속 상세정보
 ( Kaur Ushkiran ) - Sanjay Gandhi Post Graduate Institute of Medical Sciences Department of Anaesthesiology
 ( Shamshery Chetna ) - Sanjay Gandhi Post Graduate Institute of Medical Sciences Department of Anaesthesiology
 ( Agarwal Anil ) - Sanjay Gandhi Post Graduate Institute of Medical Sciences Department of Anaesthesiology
 ( Prakash Neel ) - Sanjay Gandhi Post Graduate Institute of Medical Sciences Department of Anaesthesiology
 ( Valiveru Ramya Chakrapani ) - Sanjay Gandhi Post Graduate Institute of Medical Sciences Department of Endocrine Surgery
 ( Mishra Prabhaker ) - Sanjay Gandhi Post Graduate Institute of Medical Sciences Department of Biostatistics and Health Informatics

Abstract


Background: Regional nerve blocks are an integral part of multimodal analgesia and should be chosen based on their efficacy, convenience, and minimal side effects. Here, we compare the use of pectoral (PEC II) and serratus-intercostal fascial plane (SIFP) blocks in breast carcinoma cases undergoing modified radical mastectomy in terms of the postoperative analgesic efficacy and shoulder mobility.

Methods: The primary outcome of this prospective controlled study was to compare the postoperative static and dynamic pain scores, and the secondary outcome was to assess the shoulder pain, range of shoulder joint motion, and hemodynamic parameters. Sixty patients were randomly allocated to three groups and given general anesthesia. All patients received paracetamol, diclofenac, and rescue doses of tramadol based on the institute's acute pain service policy. No block was performed in group C (control), whereas groups P and S received PEC II and SIFP blocks, respectively, before surgical incision.

Results: The groups were comparable in terms of age, weight, height, and body mass index distribution. Dynamic pain relief was significantly better 12 and 24 h postoperatively in groups P (P = 0.034, P = 0.040 respectively) and S (P = 0.012 and P = 0.017, respectively) compared to group C. Shoulder pain relief and shoulder mobility were better in group S, while the hemodynamic parameters were more stable in group P.

Conclusions: Both SIFP and PEC blocks have comparable dynamic and static pain relief with better shoulder pain scores in patients receiving SIFP.

키워드

Mastectomy; Modified radical mastectomy; Nerve block; Pectoralis muscle; Postoperative pain; Shoulder pain

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