| Objective: The experiment is to evaluate the effect of the ultrasound-guided single-point serratus plane block(SAPB),which is combined with PECS Ⅰ(pectoral nerves Ⅰ)block(hereinafter referred to as modified SAPB block)under general anesthesia on the intraoperative analgesia and the quality of early recovery after breast cancer improvement.Methods: The experiment includes 60 patients undergoing modified radical mastectomy for breast cancer under general anesthesia during elective surgery in our hospital from April 2020 to February 2021,whose sex is not limited,age is among18-65 years old,BMI is between 18-27 ㎏/㎡,ASA classification is Ⅰ or Ⅱ.Using a random number table method,60 patients were randomly divided into an ultrasound-guided modified SPB block group(group B)and a control group(group C).The number of patients in each group was 30.Patients in both groups were given total intravenous general anesthesia.Patients in the modified SPB block group were placed in the supine position.The modified SPB block on the affected side was performed under ultrasound guidance before the induction of general anesthesia.After the operation of the two groups of patients,PCIA pumps were used(the Sufentanil dose was 2μg/kg with normal saline diluted to 100 ml,the background dose was set to 3ml/h,the additional dose was 2ml per time which is controlled by the patient,the lock time was30min).The experiment recorded the main observation indicators: the QoR-40 scale is used to record the scores of the 5 sub-items and total scores of the QoR-40 scale at 1day before the operation(Day0,D0)and the first day after the operation(Day1,D1)to evaluate the early recovery quality of the two groups of patients after surgery.The experiment recorded secondary observation indicators: A.The total dosage of remifentanil,propofol and the induction and maintenance doses of cis-atracurium during the operation were recorded in the two groups of patients.B.The VAS scores of the two groups of patients were recorded at 2h,6h,and 24 h after surgery.C.When the visual analog pain score(VAS score)exceeds 4 points when lying flat,the patient automatically activates the self-control button and adds another self-control analgesic dose.Parecoxib sodium 40 mg was added as a remedial analgesia measures if pain did not relieve.The number of remedial analgesia administrations and the number of effective compressions of the PCIA pump within 24 hours after surgery were also recorded.D.Nausea and vomiting,dizziness,urinary retention,respiratory depression(SPO2 <90% or breathing <10 times),skin itching,hematoma at the puncture site,local anesthetic poisoning and other adverse reactions.Results: Compared with group C,the total QoR-40 score of D1(172.8±3.5/158.2±4.0)in group B was significantly higher on the first postoperative day(P<0.01).The scores of emotional state(42.1±0.7/40.9±1.1),physical comfort(52.7±1.9/48.7±2.0),psychological support(32.2±0.9/30.2±1.2),pain(29.9±1.4/26.3±2.1),and self-care ability(15.8±1.5/12.2±1.4)of group B on the first day after surgery were all increased(P<0.01).Compared with group C,intraoperative remifentanil dosage(1050.1±265.6/1428.5±253.2),and maintenance dose of cisatracurium(6.9±3.3/9.6±3.3),in group B were significantly less than those in group C(P <0.01).The VAS scores of resting supine and turning exercises at each time point(2h,6h,24h)in group B were significantly lower than those in group C(P<0.01).The effective number of PCIA pump compressions(1.9±1.4/5.3±2.2)and the number of rescue analgesics(0.4±0.6/2.8±1.2)in group B within 24 hours after surgery were significantly less than those in group C(P<0.01).Although the incidence of adverse reactions such as nausea and vomiting,dizziness,urinary retention,respiratory depression,skin pruritus,etc.were different between the two groups,they were not statistically significant(P>0.05).No adverse reactions such as hematoma at the puncture site or local anesthetic poisoning occurred.Conclusion: Ultrasound-guided single puncture SAPB block can effectively reduce the use of postoperative analgesics and improve the quality of early postoperative recovery in patients with breast cancer undergoing modified radical mastectomy.Therefore,ultrasound-guided single puncture SAPB block is an effective and safe analgesic method in clinical. |
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