Application Of Ultrasound-guided Erector Spinae Plane In Radical Mastectomy Of Breast Cancer

Objective:To investigate the effect of perioperative pain and inflammatory response in patients undergoing radical mastectomy with erector spinae plane block under ultrasound guidance.Methods:60 patients undergoing radical mastectomy in Rizhao people's Hospital from January to March 2019 were selected and randomly divided into the control group(group C)and the erector spinae plane block group(group E)using the random number table method,with 30 patients in each group.Patients in group E underwent tracheal intubation general anesthesia after the erector spinae plane block under ultrasound guidance.Patients in group C underwent tracheal intubation general anesthesia directly.After entered the operation room,patients in the two groups were opened the venous access and monitored the non-invasive blood pressure,heart rate,pulse oxygen saturation,electrocardiogram.Patients were treated with anesthesia induction,tracheal intubation,and connected with anesthetic machine.The anesthetic machine parameters were as follows: tidal volume was 6-7 ml/kg,respiratory frequency was 10-12 times per minute,PETCO2 was 35-45 mm Hg.The anesthesia was maintained with propofol and remifentanil pump injection until skin sutured completely.Rocuronium was added as required.The depth of anesthesia was adjusted by bispectral index(BIS),blood pressure,heart rate.MAP and HR were recorded at the time of 10 minutes before anesthesia(T0),the time of anesthesia induction(T1),the time of trachea cannula(T2),the time of skin cutting(T3),the time of skin sewing(T4),the time of tracheal extubation(T5).The dosage of remifentanil during operation was recorded.The cough and resting VAS scores were recorded at the time of 6 h after operation(Ta),the time of 12 h after operation(Tb),the time of 24 h after operation(Tc),and the time of 48 h after operation(Td).Press times of PCIA at Tc and Td were recorded.The analgesic satisfaction was assessed at Td.Blood specimens were collected at T0,T4,Ta,Tb,Tc,and Td.The concentrations of NPY,PGE2,5-HT,CRP,IL-6,and TNF-? were measured with the ELISA kits.The spontaneous respiration recoverying time,eye opening time,and extubation time were recorded.The adverse reactions were recorded within 48 h after operation.Results:(1)Compared with group C,age,there were no significant differences in the body mass index(BMI),ASA degrade,the time of operation,blood loss during operation,the spontaneous respiration recovery time,eye opening time,and extubation time in group E(P>0.05).(2)Compared with group C,the dosage of remifentanil decreased in group E(P<0.05).(3)Compared with group C,there were no significant differences in the HR and MAP at T0?T1?T2?T5(P>0.05);MAP decreased and HR decreased at T3 and T4 in group E(P<0.05).(4)Compared with group C,there were no significant differences in the patient cough and resting VAS scores(P>0.05)at Td in group E,decreased at Ta,Tb and Tc in group E(P<0.05).Compared with group C,the press times of PCIA decreased at Tc and Td in group E(P<0.05).(5)Compared with T0 in group C and group E,the concentrations of NPY,PGE2,and 5-HT increased at T4,Ta,Tb,Tc,and Td(P<0.05).Compared with group C,the concentrations of NPY,PGE2,and 5-HT decreased at T4,Ta,Tb,and Tc in group E(P<0.05).(6)Compared with T0 in group C and group E,the concentrations of CRP,IL-6,and TNF-?increased at T4,Ta,Tb,Tc,and Td(P<0.05).Compared with group C,the concentrations of CRP,IL-6,and TNF-? decreased at T4,Ta,Tb,and Tc in group E(P<0.05).Conclusions:(1)The erector spinae plane block could reduce perioperative pain in patients undergoing radical mastectomy,and improve the patients' analgesic satisfaction.(2)The erector spinae plane block could reduce the dosage of remifentanil during the operation.(3)Perioperative pain in patients undergoing radical mastectomy with erector spinae plane block might be related to the decrease of pain medium(NPY,PGE2,and 5-HT)and inflammation medium(CRP,IL-6,and TNF-?).