| Research backgroundBreast cancer is the most common malignant tumor in women,and its incidence is increasing year by year.Surgical methods are a key part of the treatment method for breast cancer.Among them,MRM preserves the patient’s pectoralis major or maximally preserves the pectoralis major and pectoralis minor at the same time.It is suitable for patients with stage Ⅰ,stage Ⅱ and some stage Ⅲ invasive cancer.The treatment plan is widely used in clinical application.Due to the extensive and complex innervation,the relatively large surgical incision,nerve injury during the operation,and postoperative psychological factors,multiple acute postoperative pain may develop into chronic pain,prolonging the postoperative recovery time.Therefore,it is necessary to explore effective methods to reduce postoperative pain in breast cancer patients.Erector spinae plane block(ESPB)is a regional block technique first described in 2016 and is the latest technique for fascial plane block.ESPB injects local anesthetics into the fascial plane between the rhomboid muscle and the erector spinae or the deep surface of the erector spinae,which may block the ventral branch and dorsal branch of the corresponding segment of the spinal nerve,reversibly block the sensory range it innervates,and achieve the corresponding segmental skin sensory analgesic effect.At present,ESPB has been successfully applied in clinical practice.The ultrasound-guided ESPB has a clear anatomical structure.The peripheral nerves and large blood vessels are less distributed,so the operation is safe and simple.In order to enhance and extend the analgesic effect and analgesic time of a single injection of ESPB anesthetics,the method of indwelling a peripheral nerve block catheter can be used,but it is inconvenient to bring the indwelling catheter from the operating room back to the ward,and it is prone to complications such as infection,catheter prolapse,skin damage,etc.Therefore,some drugs or methods are needed to improve the analgesic effect of a single injection for anesthetics.Dexmedetomidine combined with local anesthetics can enhance the intensity of analgesia,extend the time of analgesia.This method is suitable for transverse abdominis plane block,obturator nerve block,ulnar nerve block,brachial plexus block,cervical plexus block,etc which have been reported,but the addition of dexmedetomidine to local anesthetics for ESPB has not yet been seen.It’s application in ESPB lacks effective clinical research evidence.Research purposesThis article intends to explore the postoperative analgesic effect of dexmedetomidine combined with ropivacaine used in ultra-sound guided ESPB MRM.Research methods1.Sixty patients underwent MRM were enrolled into the study.2.Grouping:Random number table method was used to divide all of the patients into 2 groups(n=30).They are dexmedetomidine combined with ropivacaine group(DR group)and ropivacaine group(R group).3.Anesthesia:Both DR group and R group received unilateral ESPB before induction of general anesthesia,and the puncture level was T5 transverse process level.In the DR group,the injection drug was 30 μg dexmedetomidine and 0.5%ropivacaine for a total of 30 ml,and the R group injection drug was 0.5%ropivacaine for a total of 30 ml.After 20 minutes,the block level was detected by the ice cube method,and then general anesthesia was induced.Patients in both groups did not use pre-anesthesia medication,and all patients used patient-controlled intravenous anlgesia(PCIA)after surgery.4.Observation indicators:record the general conditions of the two groups of patients;record the operation side,ESPB operation time,operation time,surgical incision length,surgical blood loss and hospital stay of the two groups;record the block distribution of the two groups after 20 minutes of ESPB operation;record the mean arterial pressure(MAP)and heart rate(HR)when the two groups of patients enter the room(T0),20 minutes after ESPB operation(T1),immediately after induction of anesthesia(T2),immediately after skin incision(T3),and immediately after operation(T4).;record the intraoperative anesthesia maintenance drugs(remifentanil and propofol)of the two groups of patients;record the pain analogue scale(Visual Analogue Scale,VAS)of the two groups of patients after surgery(2h,6h,12h,24h,36h,48h)during resting and coughing states.0=no pain,10=the most severe pain imaginable;record the first PCIA compression time and the number of effective PCIA compressions in the two groups of patients;record the number of additional cases of flurbiprofen at 48 hours after surgery;record the postoperative bradycardia and hypotension of the two groups of patients,postoperative nausea and vomiting(PONV),and the occurrence of postoperative nerve block-related adverse reactions(hematoma,infection of blocked site,respiratory depression,etc.);record the postoperative analgesic satisfaction scores of the two groups of patients.Results1.The general conditions of the two groups of patients:age,gender,BMI,ASA classification,operative side,ESPB operation time,operation time,surgical incision length,intraoperative blood loss and hospital stay were not statistically significant(P>0.05).2.The distribution of the block plane of the two groups:there was no significant difference in the distribution of the block plane after 20 minutes of ESPB operation(P>0.05).The block planes are respectively the skin segments innervated by T2～T7,T3～T8 or T3～T9 spinal nerves.3.Comparison of intraoperative hemodynamics between the two groups of patients:at T2 and T3,the MAP of the DR group was lower than that of the R group(P<0.05);at T1,T2,T3,and T4,the HR of the DR group was lower than that of the R group(P<0.05).There was no significant difference in hemodynamics between the two groups at other time points(P>0.05).4.Intraoperative anesthesia maintenance drug consumption of the two groups of patients:the intraoperative dosage of remifentanil and propofol in the DR group was less than that in the R group(P<0.05).5.Comparison of the postoperative VAS scores of the two groups:in the resting state,at 2h,12h,36h and 48 h after the operation,the DR group had a lower VAS scores than the R group(P<0.05);in the cough state,at 6h,12h,36h and 48 h after the operation,the DR group had a lower VAS scores than the R group(P<0.05).6.The use of PCIA in the two groups:the first compression time of PCIA in the DR group was significantly later than that in the R group(P<0.05);the effective number of PCIA compressions in the DR group was less than that in the R group(P<0.05).7.The number of postoperative salvage analgesia and the occurrence of adverse reactions in the two groups:there was no statistical difference in the number of additional cases of flurbiprofen and the incidence of PONV between the DR group and the R group(P>0.05).There were no adverse reactions such as postoperative bradycardia,blood pressure drop,hematoma,infection of obstruction site,and respiratory depression in both groups(P>0.05).8.Postoperative analgesia satisfaction of the two groups:the satisfaction of postoperative analgesia in the DR group was higher than that in the R group(P<0.05).Conclusion1.The use of dexmedetomidine combined with ropivacaine in ultra-sound guided erector spinae plane block can prolong the postoperative analgesia time,improve the postoperative analgesic effect,and optimize the postoperative analgesia program after modified radical mastectomy for breast cancer.2.30μg dexmedetomidine combined with 30ml 0.5%ropivacaine in ultra-sound guided ESPB can improve postoperative analgesia effect after modified radical mastectomy for breast cancer. |
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