Effects Of Three Types Of Regional Nerve Block Guided By Ultrasound On Postoperative Pain,Immune Function And Inflammation In Patients Undergoing Radical Mastectomy Of Breast Cancer

Objective To observe the effects of anterior serratus plane block,erector spinae plane block and thoracic paravertebral nerve block on postoperative pain,inflammation and immune function of patients undergoing radical mastectomy.Methods A total of 80 female patients undergoing elective modified radical mastectomy for unilateral breast cancer were included in this trial.According to the random number table,the patients were randomly segmented into four groups: general anesthesia combined with plane block of serratus anterior(group S),general anesthesia combined with erector spinae plane block(group E),general anesthesia combined with paravertebral thoracic nerve block(group T)and general anesthesia only(group C),with 20 cases in each group.Thirty min before induction of general anesthesia,the three experimental groups were respectively subjected to ultrasound-guided plane block of the anterior serratus plane block or erector spinae plane block or thoracic paravertebral nerve block.The injected local anesthetic drugs were 0.5% Ropivacaine 20 ml,and the nerve block range of the patients in the experimental group was recorded.Induction and maintenance of total intravenous anesthesia after the determination of the range of nerve block;The mean arterial pressure and heart rate at each time point in the four groups were monitored.The dosage of propofol and analgesic drugs during the operation,the duration of the operation,and the amount of bleeding during the operation;The numerical rating scale(NRS)of cough and pain in resting state at 1h,6h,12 h,24h and 48 h after operation and the serum IL-6,IL-10,TNF-a,Ig A,Ig G and Ig M contents of the patients in the four groups at the time points of entering the room,immediately after operation,and 24 h and 48 h after operation were compared.SPSS25.0 was used for statistical analysis of the above data.Results The block range of patients in group S was smaller than those in group E and group T.The amount of remifentanil used during the operation in the patients of group S,group E and group T was smaller than that in group C(P<0.05).The NRS score of the group S was lower than that of the group C only within 12 h after operation,and the NRS scores of the patients in the group E and the group T were lower than that of the group C within 48 h after operation(P<0.05).There was no significant difference in the contents of serum IL-6,IL-10,TNF-a,IgA,IgG and IgM among the four groups at different time points(P>0.05).Conclusion All the three kinds of nerve block can provide good analgesia for patients with modified radical mastectomy.The analgesic time of ESPB and TPVB was longer than that of SAPB.ESPB is more recommended as the main method of postoperative analgesia for patients undergoing modified radical mastectomy.