Effects Of Ultrasound-guided Serratus Anterior Plane Block On Pain Syndrome In Patients Undergoing Breast Cancer Surgery

Background and objectiveBreast cancer is currently the most common malignant tumors in women worldwide.With the advancement of early diagnostic and treatment methods,the 5-year survival rate of breast cancer patients has been significantly improved.Surgery is one of the effective methods for treating breast cancer.About 25%?60%patients develop post-mastectomy pain syndrome(PMPS)after surgery treatment,which is mainly located in and around the surgical area and can last more than 3 months.It is difficult to effectively treat chronic postoperative pain,which seriously affects the quality of postoperative life of patients and brings economic burden to their families.Therefore,the occurrence of PMPS should be actively prevented.Serratus anterior plane block(SAPB),as a safe and easy-to-operate regional nerve block technique,can provide good analgesia for anterolateral chest wall surgery.Studies have shown that the analgesic effect of the SAPB is equivalent to that of the thoracic epidural analgesia while the complications are fewer than thoracic epidural analgesia.In recent years,with the development of ultrasound technology,the clinical application of nerve block technology has become more common.Studies have shown that SAPB can alleviate the degree of acute pain after breast cancer surgery.However,little research has been done on the effects of preoperative S APB on PMPS in radical mastectomy.In this study,postoperative follow-ups were implemented to assess the postoperative acute and chronic pain related indicators,and explore the effects of preoperative ultrasound guided SAPB on PMPS.Materials and MethodsThe study was approved by ethic committee of First Affiliated Hospital of Zhengzhou University.Informed consents were signed by all of patients and their families.A total of 110 female patients underwent elective unilateral modified radical mastectomy from July 2018 to December 2018 were recruited into the study.Patients were randomly divided into the serratus anterior plane block group(group T)and the control group(group C)according to the random number table.The perioperative opioid consumption was recorded.Visual analogue scale(VAS)of resting state and exercise state were recorded and compared at 24 hours,48 hours,3 months and 6 months postoperatively.The incidence of PMPS were recorded at 3 months and 6 months postoperatively.The SF-36 score,SF-MPQ score,and Baker depression scale score were recorded at 6 months postoperatively.Statistical analysis was performed by SPSS 22.0.A P<0.05 was considered statistically significant.Results1.87 patients were finally included in the analysis,44 in group T and 43 in group C.There were no significant differences in general information(P>0.05).2.There were no significant differences in sulfentanil consumption during anesthesia induction(P>0.05).The perioperative remifentanil consumption in group T were significantly less than that in group C(P<0.05).3.Compared with group C,patients in group T had lower VAS scores in resting state and exercise state at 24 hours and 48 hours postoperatively,the differences were statistically significant(P<0.05).4.Compared with group C,patients in group T had lower VAS scores in resting state and exercise state at 3 months and 6 months postoperatively,the differences were statistically significant(P<0.05).The incidence of PMPS in group T was lower than that in group C,the differences were statistically significant(P<0.05).Patients in group T had higher SF-36 scores at 6 months postoperatively,the differences were statistically significant(P<0.05).The SF-MPQ scores and Baker depression scale scores of patients in group T were lower than those in group C at 6 months postoperatively,the differences were statistically significant(P<0.05).Conclusion1.Compared with general anesthesia alone,combined with ultrasound-guided serratus anterior plane block can effectively relieve the acute pain of breast cancer patients and reduce the perioperative opioid consumption.2.Preoperative ultrasound guided serratus anterior plane block can reduce the incidence of PMPS in breast cancer patients at 3 months and 6 months postoperatively,effectively alleviate chronic pain and improve the patients' physical and mental health and the quality of life.