Effect Of General Anesthesia Combined With Pectoral Nerve Block Used In Modified Radical Mastectomy

Objective:To investigate the effect of general anesthesia combined with pectoral nerve block on postoperative recovery and acute and chronic pain.Methods:Sixth three patients,ASA class Ⅰ～Ⅱ,who were undergoing modified radi cal mastectomy under general anesthesia,aged 18 to 65 years old,were randomly divided into 2 groups:receive general anesthesia alone group(group C,n=30),general anesthesia combined with pectoral nerve block group(group P,n=33).Fasting and ban drink preoperative,and insert an intravenous line and radial atrerypuncture afterentering the operating room.All paitients were mornitoring non-invasive blood-pressure,invasive arterial blood pressure,electrocardiogram,heart rate,pulse oxygen saturation an BIS.Patients in group Preceived application of ultrasound guided pectoral nerve Ⅰ and Ⅱ block before induction of anesthesia.Induction of anesthesia:fentaynl at 0.002mg/kg,cisatracurium at 0.2mg/kg,midazolam at 0.05mg/kg,dexamethasone at 10mg.Propofol was injected with TCI.Target lasma concentration of propofol was set to 4ug/ml at the beginning of anesthesia induction.Maintenance of anesthesia:propofol and remifentanil combined.Target lasma concentration of propofol was set to 1.5～4.5ug/ml,remifentanil at 0.05～2ug/kg/min.The range of BIS should be controlled 40 to 60,according to vital signs and BIS to adjust anesthetic dosage.Mean arterial pressure,heart rate,setting parameters for target plasma concentration of propofol before induction of anesthesia(TO),after induction of anesthesia(T1),after skin-cutting(T2),30min after skin-cutting(T3),60min after skin-cutting(T4),90min after skin-cutting(T5),surgery ending(T6),10min after waking up(T7),20min after waking up(T8),30min after waking up(T9) of each group were Recorded.Patient followed by patient-controlled intravenous analgesia(PCIA)after surgery(sufentanil 100ug,dizocine 10mg,azastron 10mg).Drug use,recovery time of spontaneous breathing,recovery time of directional force,time of living bed after operation were recorded.Number of times analgesics needed,Sleep quality score,incidence of PONV 24h after operation were recorded.SF-MPQ was recorded on 0.5h,1h,2h,12h,24h,7d,1month,3month after surgery.Results:(1)Comparison of hemodynamic shows:There were no significant differences in MAP and HR between the two groups at TO.MAP:MAP of group P at T2,T4 and T5 was significantly lower than that of group C,and the difference was statistically significant(P<0.05),especially significant at T2(P<0.01).HR:HR of group P at T2,T4,T5,T7,T8 and T9 was significantly lower than that of group C,and the difference was statistically significant(P<0.05),especially at T2(P<0.01).(2)Comparison of consumption of drug shows:Total consumption of remifentanil and Average parameters of TCI of group P were significantly lower than that in group C,and the difference was statistically significant(P<0.001).(3)Comparison of postoperative recovery shows:Compared with group C,recovery time of spontaneous breathing,recovery time of directional force,time of living bed after operation and number of times analgesics needed of group P were significantly decreased,and the difference was statistically significant(P<0.01).Sleep quality score of group P were significantly higher than that in group C,and the difference was statistically significant(P<0.05).(4)Comparison of SF-MPQ after surgery shows:PRI-S:PRI-S of group P at 0.5h、1h、2h、12h、24h、7d was significantly lower than that of group C,and the difference was statistically significant(P<0.05),especially significant at 0.5h、1h、2h(P<0.01).PRI-A:PRI-A of group P at 0.5h、1h、2h、12h、24h was significantly lower than that of group C,and the difference was statistically significant(P<0.05),especially significant at 24h(P<0.01).VAS:VAS of group P at 0.5h、1h、2h、12h、24h、7d、1mon was significantly lower than that of group C,and the difference was statistically significant(P<0.05),especially significant at 0.5h、1h、2h、1211(P<0.01).PPI:PPI of group P at 0.5h、lh、2h、12h、24h、7d、1mon was significantly lower than that of group C,and the difference was statistically significant(P<0.05),especially significant at 0.5h、1h、2h(P<0.01).(5)Comparison of adverse reactions shows:Compared with group C,the incidence of PONV and PMPS were no significant differences.Conclusions:Compared with pure general anesthesia,general anesthesia combined with pectoral nerve block can reduce anesthetics dosage,make the hemodynamics more stable and accelerate the postoperative recovery.It can control the acute pain well after operation but the effect on chronic pain was no significant.