Clinical Effect Of Ultrasound-guided Serratus Anterior Plane Surgical Block For Analgesia In Breast Cancer

Purpose:For patients undergoing surgery for breast cancer,observe the analgesic effect of anterior serratus plane block under preoperative ultrasound-guided during and after operation,and further explore the effectiveness and safety of this technology in perioperative analgesia.Method:A total of 60 female patients who underwent surgical treatment for breast cancer from October 2021 to January 2022 in China-Japan Union Hospital of Jilin University were selected,all patients were obtained their informed consent before surgery,all patients were older than 18,and according to the American Association of Anesthesiologists physical status classification system,they were all graded Ⅰ-Ⅱ.The above patients were randomized into three groups of 20 patients each.The anesthesia and analgesia plans of each group were as follows--In group A,general anesthesia was used,and analgesic pump was used after operation;Group B: general anesthesia combined with serratus anterior plane block was used,and analgesic pump was used after operation;Group C: general anesthesia combined with serratus anterior plane block was used,and low opioid analgesic pump was used after operation.Group A was the control group,and nerve block was not performed after anesthesia.Group B and C were the experimental groups,patients of these groups were all underwent ultrasound-guided serratus anterior plane block on the operated side after induction of anaesthesia.The concentration and volume of local anaesthetic used for block in this experiment were0.375% ropivacaine of 20 ml.Postoperative intravenous patient-controlled analgesia pump was used in all three groups.The analgesic pump formulation used in A and B groups was: sufentanil 2ug/kg,flurbiprofen2mg/kg,tropisetron 10 mg,the above drugs were prepared into 100 ml using 0.9% sodium chloride solution;The analgesic pump formulation used for patients in group C was: sufentanil 1ug / kg,other drugs and doses were the same as those in groups A and B.Observe and record the following indicators of each group: general data（age,height,weight,BMI）and anesthesia time;Heart rate,mean arterial pressure at the time of room admission（T0）,while intubated（T1）,at the time of skin incision（T2）,and at the time of extubation（T3）;Intraoperative drug consumption of sufentanil,remifentanil,sevoflurane;The scores of pain at the time of immediately（t 0）,2 hours（t 1）,6 hours（t 2）,12 hours（t 3）and 24hours（t 4）after operation,as well as the occurrence of nausea and vomiting,respiratory depression,urinary retention and skin pruritus at the corresponding time points.Result:All the 60 patients completed the experiment,and the general data（age,height,weight,BMI）and anesthesia time of the three groups were not statistically significant（P> 0.05）.There were no statistical differences in heart rate and mean arterial pressure levels among the three groups at t0 and T1（P > 0.05）;The heart rate and mean arterial pressure of patients in groups B and C at T2 and T3 were lower than those in group A,and the differences were statistically significant（P < 0.05）.Differences between B and C groups in heart rate and mean arterial pressure at each time point were not statistically significant（P > 0.05）.There was no statistically significant difference in sevoflurane consumption during anesthesia among the three groups（P>0.05）;Remifentanil and sufentanil consumption was higher in group A than in groups B and C,and the differences were statistically significant（P <0.05）.There were no statistical difference in pain scores at the postoperative time points between the three groups（P> 0.05）.The overall incidence of adverse reactions of dizziness,nausea and vomiting in group C was lower than that in groups A and B.None of the three groups saw other adverse reactions,including respiratory depression,skin pruritus,constipation,or urinary retention.Conclusion:In breast cancer surgery,general anesthesia combined with preoperative ultrasound-guided serratus anterior plane block can provide good analgesic effect during and after operation,and is more conducive to maintaining stable hemodynamics during operation and reducing total dose of opioid in and after surgery.