Effect Of Pectoral Nerve Block And Erector Spinae Plane Block On Postoperative Pain And Early Recovery Quality In Patients With Breast Cancer

BACKGROUND: The incidence of breast cancer is the first among Chinese female.Modified radical mastectomy is one of the main treatments for breast cancer.The incidence of postoperative acute pain after breast cancer surgery was more than 35%,which affects the quality of life.Peripheral nerve block technology has been proven to be effective in relieving postoperative pain and improving postoperative quality of recovery.Ultrasound-guided pectoral nerves(Pecs)II block is an interfascial block technique with simple operation and a few complications,which can provide complete analgesia for the anterolateral chest wall.The main indication is modified radical mastectomy with axillary lymph node dissection.Ultrasound-guided erector spinae plane(ESP)block is a novel trunk nerve block technique which is easy to operate and has a wide range of block.It was reported that ESP block exhibits a significant analgesic effect in patients undergoing breast cancer surgery.The main purpose of this study was to compare the effects of ultrasound-guided Pecs II block and ESP block on postoperative pain and early recovery quality of patients undergoing unilateral modified radical mastectomy surgery.METHODS: A total of 90 women were screened for our study.Patients undergoing unilateral modified radical mastectomy surgeries under general anesthesia from June 2018 to June 2019,the age of 18-70 years,Body Mass Index(BMI)<30 kg/m2,American Society of Anesthesiologists(ASA)physical status I or II.Patients who met the inclusion criteria were allocated randomly and divided into three groups by using computer random number table: Group P(Pecs II block combined with general anesthesia),Group E(ESP block combined with general anesthesia),and Group C(general anesthesia alone),30 cases in every group.Group P received ultrasound-guided pectoral nerves block with 25% ropivacaine 25 ml before induction of anesthesia.Group E received ultrasound-guided erector spinae plane block with 25% ropivacaine 25 ml before induction of anesthesia.Group C received general anesthesia only.All patients underwent general anesthesia,and intravenous ketorolac tromethamine 60 mg was administered to prevent postoperative pain.The numerical rating scale(NRS)scores were observed and recorded at 3 h,6 h,12 h,and 24 h after surgery.Intraoperative sufentanil consumption,the total number of cases of rescue analgesic requirements within 24 h after surgery,morphine consumption,were recorded.The 40-item quality of recovery(Qo R-40)scores were recorded one day before surgery and 24 h after surgery.Heart rate(HR)and mean arterial pressure(MAP)of before operation(T0),after induction of anesthesia(T1),immediately after skin-cutting(T2),30 minutes after skin-cutting(T3),60 minutes after skin-cutting(T4),90 minutes after skin-cutting(T5)and surgery ending(T6),were recorded.Postoperative opioid-related adverse reactions,satisfaction scores,and nerve block complications were recorded.RESULTS:(1)The NRS scores of group P at 3 h,6 h,and 12 h after operation were significantly lower than that of group E and C,and there were a significant difference(P <0.01).There was no statistically significant difference in the NRS scores of the three groups of patients at 24 hours after operation(P >0.05).(2)Intraoperative sufentanil consumption of group C was significantly higher than it of groups P and E(P <0.01),the total number of cases of rescue analgesic requirements within 24 h after surgery was significantly lower in group P than it in groups C and E(P <0.05),the morphine consumption of group P was significantly lower than it of group C(P <0.05),and there were a significant difference.(3)The preoperative Qo R-40 total scores and the scores of every dimension have no significant difference among three groups(P >0.05),which were comparable.Comparison of postoperative Qo R-40 total scores,postoperative physical comfort dimensions,and postoperative pain dimensions among the three groups of patients showed significant differences(P <0.05).The Qo R-40 total score of group P at 24 h after surgery was significantly higher than it in group C(P <0.05),the score of postoperative physical comfort in group P and group E was significantly higher than it in group C(P <0.05),and the score of postoperative pain in group P was significantly higher than it in group E and group C(P <0.01).(4)All patients in the three groups began to decrease significantly at T1 HR and MAP,and then stabilized after a short rise at T2(the time point: P <0.01).The changes of HR and MAP in group C were more significant than those in group P and E(the interaction between the groups: P <0.01),and there were statistically significant differences in HR and MAP between group P and group C(P <0.01),and no statistically significant differences between group P and group E,group E and group P(P >0.05).There was no significant difference in HR and MAP about interaction between groups and time points(P >0.05).(5)There were no significant differences in adverse reactions(nausea,vomiting,dizziness,skin itching)in the three groups of patients after 24 hours(P >0.05).(6)The satisfaction of patients in group P and E at 24 h after operation were higher than it in group C,but the difference were no statistically significant(P =0.118).(7)There were no nerve blockrelated complications in the three groups.CONCLUSIONS: Ultrasound-guided Pecs II block or ESP block during modified radical mastectomy can reduce the consumption of analgesics,improve the early recovery quality,maintain hemodynamic stability during anesthesia.In addition,the analgesic effect of Pecs II block is better than ESP block.