Optimization strategies of anesthesia for modified radical mastectomy: pecto-intercostal fascial block-pectoral nerve block type Ⅱ-general anesthesia
10.3760/cma.j.cn131073.20230311.00712
- VernacularTitle:乳腺癌改良根治术麻醉的优化策略：胸肋间筋膜阻滞-胸部神经Ⅱ型阻滞-全身麻醉
- Author:
Dawei YANG
1
;
Yao WANG
;
Jianyou ZHANG
;
Rongrong MA
Author Information
1. 扬州大学附属医院麻醉科，扬州 225000
- Keywords:
Fascia;
Thoracic nerves;
Nerve block;
Anesthesia, general;
Mastectomy, modified radical
- From:
Chinese Journal of Anesthesiology
2023;43(7):823-826
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy of pecto-intercostal fascial block (PIFB)-pectoral nerve block type Ⅱ (PECS Ⅱ block)-general anesthesia for modified radical mastectomy.Methods:Forty-six patients, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, aged 40-65 yr, scheduled for elective modified radical mastectomy, were divided into 2 groups ( n=23 each) using a random number table method: PECS Ⅱ block-general anesthesia group (group P+ G) and PIFB-PECS Ⅱ block-general anesthesia group (group P+ P+ G). The patients received ultrasound-guided PECS Ⅱ block (P+ G group) or PIFB combined with PECS Ⅱ block (P+ P+ G group) in the pre-anesthesia room. Then the patients were admitted to the operating room, and midazolam, propofol, sufentanil and cisatracurium were used for anesthesia induction, and sevoflurane, remifentanil and cisatracurium were used for anesthesia maintenance. The intraoperative consumption of remifentanil, emergence time and extubation time were recorded. Flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic after operation, and visual analog scale score was maintained ≤3 at rest. The requirement for rescue analgesia and occurrence of nausea and vomiting within 24 h after operation were recorded. Results:Compared with group P+ G, the intraoperative consumption of remifentanil was significantly decreased, the emergence time and extubation time were shortened, the rate of rescue analgesia within 24 h after operation was decreased, the time of first rescue analgesia was prolonged ( P<0.05), and no significant change was found in the incidence of nausea and vomiting in group P+ P+ G ( P>0.05). Conclusions:Compared with PECS Ⅱ block-general anesthesia, PIFB-PECS Ⅱ block-general anesthesia can reduce the amount of intraoperative opioids, inhibit postoperative hyperalgesia and promote early postoperative recovery when used for modified radical mastectomy.
