Effect Of Transversus Thoracic Muscle Plane-pectoral Nerves Block Under Ultrasonic Guidance On Patients With Modified Radical Mastectomy

ObjectiveTo investigate the analgesic effect,immune regulation and related factors of tumor metastasis and recurrence of transversus thoracic muscle plane-pectoral nerves block(TTP-PECS)combined with general anesthesia in modified radical mastectomy.Methods1.Forty female patients,which aged 18-65 yrs,with body mass index of 18-25kg/m2,of American Society of Anesthesiologists physical status ? or ?,scheduled for elective unilateral modified radical mastectomy were enrolled in our study.2.Groups:Random number table method was used to divide all patients into two groups(n=20):general anesthesia combined with transverse thoracic muscle plane-pectoral nerve block(group TP)and general anesthesia group(group GA),with 20 patients in each group.3.Anesthesia methods:30min before induction of general anesthesia,the TP group underwent ultrasound guidedtransverse thoracic muscle plane-pectoral nerve block of the affected side.Specific practice isinjectthe local anesthetic 0.33%ropivacaine into the space between the pectoralis minor and the serratus anterior,then withdraw the puncture needle into the pectoralis major and pectoralis minor space and inject 0.33%ropivacaine 10ml.The intrafascial plane between the internal intercostal muscle and the transverse thoracic muscle was injected with 15 ml 0.33%ropivacaine.Both the group GA and the group TP underwent intravenous general anesthesia.Intraoperative anesthesia maintenance protocol was used in all patients to pump propofol and remifentanil to maintain a BIS value of 45-55,and various vital signs fluctuated within the normal range.All vital signs fluctuated within the normal range.All patients were given intravenous controlled analgesia(PCIA)after surgery.4.Observation indicators:The intraoperative hemodynamic changes and consumption of propofol and remifentanil wererecorded,and the resting VAS score and PONV score were recorded at 2,12,24,and 48 hours after operation.5ml of peripheral venous blood samples were taken from the two groups at room time,after surgery,24 and 48 hours after surgery,and flow cytometry were used to measured the levels of CD3+,CD4+,CD8+and the ratio of CD4+/CD8+of peripheral Tlymphocyte subsets.And the concentrations of PGE2,TNF-? and VEGF-C in plasma were determinedby enzyme linked immunosorbent assay.Perioperative adverse events were recorded.5.Statistical methods:SPSS 22.0 statistical software was used for data processing.Normally distributed measurement data were expressed as mean±standard deviation(x±s).Comparisons between groups were tested by group t test;Mann-whitney U test was used for non-parametric data,and P<0.05 was considered a statistical difference.Results1.General data:No significant difference was found in general data among the groups(P>0.05).2.Perioperative indicators:No statisticallysignificant difference were found in hemodynamics indexes between the two groups before surgery(P>0.05).After skin cutting,MAP and HR were significantly lower in the group TP than those in the group GA(P<0.05),and no statistically significant difference were found in hemodynamics between the two groups at the other time points(P>0.05).Compared with the GA group,the propofol and remifentanil doses in the TP group were significantly reduced(P<0.05).3.Postoperative PONV and VAS scores:Compared with the group GA,the VAS score of the group TP was significantly lower at 12 hours after surgery(P<0.05),no statistical differences were found in VAS score at the remaining time points.The PONV scores of the group TP were significantly lower than those of the group GAat 12h after surgery and 24h after surgery(P<0.05).There was no significant difference in the PONV scores between the two groups at the remaining time points(P>0.05).There were no complications such as hematoma and pneumothorax in both groups.4.Perioperative immune indicators:There were no significant differences in the levels of CD3+,CD4+,CD8+and the ratio of CD4+/CD8+between the two groups of patients before surgery(P>0.05).CD4+T cells in the group TP were significantly increased compared with the group GA after surgery(P<0.05).There was no significant difiference in CD4+T cells between the two groups at the other time points.There was no significant difference in CD3+T cells,CD8+T cells,and CD4+/CD8+between the two groups at each time point.5.Perioperative indicators of inflammation and tumor metastasis and recurrence:There were no significant differences in plasma PGE2,TNF-?,and VEGF-C concentrations between the two groups of patients before surgery(P>0.05).Compared with the group GA,the concentrations of PGE2 and TNF-? in the group TP were significantly reduced after operation(P<0.05).No significant difference were found in theconcentrations.of PGE2 and TNF-a between the two groups 24 and 48 hours after surgery.In the group TP,the VEGF-C concentration decreased significantly after surgery and 24 hours after operation(P<0.05).No significant difference were found in VEGF-C concentration between the two groups 48 hours after surgery.ConclusionTransversus thoracic muscle plane-pectoral nerve block combined with general anesthesia can provide effective perioperative analgesia for patients with modified radical mastectomy,reduce complications,regulate immune response,reduce the inflammatory response,and the level of tumor growth and metastasis factor,which is beneficial to postoperative recovery.