Evaluation Of Analgesic Effect Of Ultrasound-guided Pectoral Nerve Block In Modified Radical Mastectomy:for Breast Cancer

Objective:Pectoral nerve blocks（Pecs）with ropivacaine is a newer analgesic technique for breast cancer surgery.However,it has not been reported that which concentration and dose of ropivacaine is best for analgesia.In this study,we evaluated the safety and efficacy of different concentrations of ropivacaine given in the same volume for Pecs I and II in patients undergoing modified radical mastectomy.Methods:One hundred twenty patients undergoing elective modified radical mastectomy,ASAⅠ-Ⅱlevel,were randomly divided into three groups（R group）and one control group（sham group）,with 30 cases in each group.The observation group was further divided into R_0.2%group,R_0.3%group and R_0.4%group.The observation group was treated with Laryngeal Mask Airways combined with Pecs block and intravenous inhalation combined with general anesthesia,in which Pecs block ropivacaine concentration was 0.2%in the observation group R_0.2%group,Pecs block ropivacaine concentration was 0.3%in the observation group R_0.3%group,and Pecs block ropivacaine concentration was 0.4%in the observation group R_0.4%group.The sham group received laryngeal mask airway intravenous inhalation combined with general anesthesia,In a volume of 20 ml ropivacaine in all three groups.24 hours of sufentanil PCIA was performed postoperatively.General information of patients was recorded,operation time,anesthetic time,opioid and propofol use type and dose,patient recovery time,static and dynamic NRS scores of postoperative patients at 3h,6h,12h,24h,48h and 72h were recorded.Number of analgesic pump compressions,and incidence of nausea and vomiting within 24h,postoperative adverse events,and patient satisfaction were recorded6h and 48h after surgery in 4 groups,Is expressed as 1 to 10 points,of which 10is a perfect score.Results:Intraoperative,R_0.3%R_0.4%and R_0.2%compared with the sham group the postoperative recovery time,the satisfaction scoresdosage of propofol,Remifentanil dosage and the static and dynamic scores of NRS was statistically significant（P<0.05）,NRS scores of 12h,24h and 48h in R_0.4%group were significantly lower than those in R_0.2%group and R_0.3%group（P<0.05）.Postoperative analgesia pump compressions and in R_0.4%group were significantly lower than those in sham group,R_0.2%group and R_0.3%group（P<0.05）.The incidence of postoperative nausea in R_0.2%,R_0.3%and R_0.4%groups were lower than that in the sham group（P<0.05）.There was no significant difference in the incidence of vomit in the four groups.Conclusions:1.Ultrasound-guided Pecs I and II analgesia provided both effective intraoperative analgesia and satisfactory postoperative analgesia,significantly reduced the dosage of propofol and opioids,shortened the postoperative recovery time of patients,improved the satisfaction of patients,and reduced the incidence of postoperative nausea.2.Under the conditions of this experiment 0.4%was the more appropriate concentration of ropivacaine for Pecs I and II analgesia in patients undergoing modified radical mastectomy surgery,providing both good intraoperative analgesia and no neurotoxicity and other adverse reactions.