Ultrasound-guided Serratus Plane Block For QoR-40 After Modified Radical Mastectomy

Objective In China,breast cancer is the most frequent cancer Currently.The popularity of breast cancer screening and improvement of operation method result in disability adjusted life year(DALY)of breast cancer presents a rising tendency,the social burden of disease will also increase.The common method for postoperative analgesia for breast cancer such as epidural anesthesia,thoracic paravertebral block,automatic intravenous analgesia(PCIA)and so on,all of them can achieve the purpose of postoperative analgesia,though the technology has its limitations.Recent studies show that: ultrasound-guided serratus plane block(SPB)can provide better analgesia,but the postoperative quality of recovery was unclear for breast cancer patients.Methods Patients(18 to 65 years old)with American Society of Anesthesiologists’(ASA)Physical Status class I-II scheduled for first modified radical mastectomy were included in the study.All objects were randomly divided into two groups,the general anesthesia group(group control)or SPB(serratus plane block)+ general anesthesia groups(group SPB),the SPB group has 35 cases while 34 cases in the control group.SPB was not performed before induction,and the anesthesia was applied as mentioned above,and intravenous PCIA was used postoperatively in control group.Before operation begin and complete anesthesia induction,patients were received an ultrasound-guided SPB in SPB group.All patients received a standard anesthetic protocol.General anesthesia was induced with intravenous protocol,sufentanil and cis-atracurium.A laryngeal mask(LMA Supreme TM)was placed to maintain airway open,and the ETCO2 was fluctuated in 35-45 mmHg.Anesthesia was maintained with sevoflurane(2–3%)in the procedure,and the depth of anesthesia was adjusted according to the BIS(40~60)and hemodynamics.Intravenous unified formula PCIA was taken after surgery.To evaluate the patient recovery using the Quality of Recovery 40 questionnaire(QoR-40)as primary outcome.Secondary outcomes included postoperative pain scores assessed using Visual Analogue Scale(VAS)to evaluate the pain in 0.5 hours,2 hours,4 hours,6 hours,8 hours and 24 hours after the surgery,other recovery quality indicators: postoperative nausea,vomiting,itching,incidence of respiratory depression,dizziness and bradycardia.Results We could not find any statistically significant differences among the groups in the patients’ preoperative QoR-40 total score baseline,the SPB group was significantly higher than control group(P<0.01)in the physical comfort and pain,there were no differences between the 2 groups in emotional state,physical independence and psychological support(P>0.05).There were no differences among the 2 groups in VAS score measured after 0.5 hours,2 hours,4 hours,6 hours and 8 hours postoperative(P<0.05),VAS score measured after 24 hours postoperative shows significant reduction in group SPB(P<0.05).There were no differences among the 2 groups in the postoperative complications of nausea,vomiting,differences(P< 0.05),2 groups with no significant in itching,dizziness,respiratory depression and bradycardia(P>0.05).Conclusion In a word,using ultrasound-guided serratus plane block with PCIA is superior to using PCIA alone for lower pain and higher quality life of recovery in modified radical mastectomy of breast cancer patients after surgery.