| Objective:To explore the anesthetic effect of erector spinae plane block(ESPB)with ropivacaine in various concentrations in the perioperative period of modified radical mastectomy for breast cancer,and to enrich clinical anesthesia.Methods:120 female patients who underwent unilateral modified radical mastectomy in Chengde Central Hospital from September 2021 to September2022 were selected.The patients were randomised into 4 groups,each group had 30 cases.The 4 groups were named experimental group S1,group S2,group S3 and control group C seperately.Grouping was designed according to the randomisation scheme strictly.The anesthesia method of the experimental group was total intravenous anesthesia combined with ESPB.0.25%,0.375%and 0.5% ropivacaine were used for ultrasound-guided ESPB in S1,S2 and S3 respectively before anesthesia was administratered.The volume of local anesthetic was 30 ml.Used total intravenous anesthesia for group C.Observation indicators:(1)Pain index(Pi): collected Pi at the time of pulling out the laryngeal mask(T0),leaving the operating room(T1),entering the anesthesia recovery room(T2),15 min into the anesthesia recovery room(T3),and leaving the anesthesia recovery room(T4);(2)Postoperative pain indicator(VAS score): collected VAS score at 1h,6h,12 h,24h and 48 h after operation;(3)Postoperative recovery quality indicator: collected QoR-15 score at24 h after surgery;(4)Intraoperative anesthetic dosage indicators: recorded the dosage of remifentanil,sufentanil and propofol;(5)Hemodynamic parameters: collected mean arterial pressure(MAP)and heart rate(HR)at the moment of pre-anesthesia(Ta),skin incision(Tb),30 min after starting the surgery(Tc),end of surgery(Td),24 h after surgery(Te);(6)Postoperative living ability rehabilitation indicators: recorded ambulation time,time to start eating and postoperative hospital stay;(7)Perioperative adverse reaction indicators: recorded early-stage adverse reactions after block(dizziness,tinnitus,muscle twitching and tremor and arrhythmia),postoperative adverse reactions(nausea,vomiting,dizziness and respiratory depression).Results:1 Comparison of general dataThe disparation of Age,ASA classification,BMI and operation time did not have the significance among the four groups(P>0.05).2 Comparison of pain index(Pi)Pi in group C from T0 to T4 was significantly higher than that in group S1,S2 and S3(P<0.05).Pi in group S1 from T0 to T4 was significantly higher than that in group S2 and S3(P<0.05).The disparation between group S2 and S3 did not have the significance(P>0.05).3 Comparison of postoperative pain indicatorAt 6h,12 h,24h and 48 h after finishing the surgery,the VAS at rest and during movement revealed that S1,S2 and S3 were far less than group C(P<0.05).The disparation among S1,S2 and S3 at rest and during movement did not have the significance at all time points(P>0.05).4 Comparison of postoperative recovery quality indicatorThe QoR-15 score of group S1,S2 and S3 was overtop group C(P<0.05),and this indicator of group S2 was overtop that of group S1 and S3(P<0.05).5 Comparison of intraoperative anesthetic drug dosage indicatorsThe intraoperative volume of remifentanil and sufentanil in group S1,S2 and S3 was less than that in group C(P<0.05),and significant disparation among S1,S2 and S3 did not exist(P>0.05).The propofol volume disparation among the four groups did not have the significance(P>0.05).6 Comparison of hemodynamic parametersThe disparation of MAP and HR at the time from Ta to Te among the four groups did not have the significance(P>0.05).7 Comparison of postoperative living ability rehabilitation indicators:The postoperative hospital stay of group S1,S2 and S3 was less than group C(P<0.05).The disparation of ambulation time and time to start eating among the four groups did not have the significance(P>0.05).8 Comparison of perioperative adverse reactions4 patients had dizziness in group S3,and 1 patient had muscle twitching and tremor in group S3 at the early-stage after block.The incidence of postoperative nausea,vomiting and dizziness in group C was significantly higher than that in group S1,S2 and S3(P<0.05).Conclusions:Ultrasound-guided 0.375% ropivacaine for erector spinae plane block can make the best anesthetic effect on perioperative period in modified radical mastectomy for breast cancer. |
PDF Full Text Request