الفهرس | Only 14 pages are availabe for public view |
Abstract Breast surgeries are the mainstay treatment of breast cancer. It is one of the most common surgeries due to the very high incidence of breast cancer. The surgery is associated with a considerable post-operative pain that constitutes a major problem for anesthetists due to complex innervation of the breast and dissections of both thoracic and axillary region. Appropriate pain treatment aims to improve the results of the surgery, reduce postoperative morbidity, decrease the incidence of chronic postsurgical pain and decrease the duration of hospital stay. Treatment of postoperative pain after breast surgery is based on conventional drugs for pain relief (large doses of paracetamol, NSAID, and oral or intravenous opioid). This is associated with adverse effects, such as nausea, sedation, hypotension and increased cardiac load. All these effects delay rehabilitation, overall recovery and discharge. Here the role of the regional block appears to overcome these side effects for the management of acute postoperative pain in breast surgeries. Recently, ultrasound-guided technique regional block has been used successfully to avoid the problems of the blind technique and provided better control of a variety of postoperative pain. The erector spinae plane (ESP) block is a safe, simple and effective regional anesthesia technique that can be used to provide analgesia for a variety of surgical procedures. Regarding breast surgeries, it is considered a safe alternative to the paravertebral block, which is a particularly challenging technique because of the anatomic proximity of the pleura and central neuraxial system. The aim of our study was to evaluate the efficacy of the ultrasound guided erector spinae plane block as a postoperative analgesia in elective unilateral breast surgery. This study was conducted on 60 female patients aged ≥ 20 to ≤ 60 years old, ASA physical status I_II who were scheduled for elective unilateral breast surgery. Patients were randomized into two groups, 30 Patients in each group. group 1: (Control group) Patients received only general anesthesia. group 2: (Erector spinae plane block group) Patients received US-guided ESP block with 20 ml of 0.25% bupivacaine and 8mg. dexamethasone as a local anesthetic adjuvant after general anesthesia. Parameters of assessment were Static and dynamic Postoperative pain was assessed using a visual analogue scale (VAS) every 2hrs for the 1st 8hrs and every 8hrs for the remaining 24 hrs. post-operatively. total morphine and paracetamol consumption during the 24-h postoperative period. time to the first request for rescue analgesia (when VRS was 4 or more). Perioperative hemodynamics (HR- MAP). Incidence of postoperative complications. The main results were as follow Both groups were comparable regarding the demographic data and the type of surgery. ESPB group showed a significantly lower VASstatic score than the control group at 0 time (half an hour after recovery), 2h, and 4h postoperatively (p<0.001). Also, the VASdynamic score was significantly lower in the ESPB group than in the control group at 0 time, 2h, 4h, and 6h postoperatively (p<0.001). The time until the first required analgesia was significantly longer in ESPB group than the control group (5(3-6) vs. 0.5(0.5-0.5) in hours, respectively; with p<0.001); while the post-operative 24h morphine consumption was significantly lower in ESPB group than the control group (2.30± 2.18 mg vs.10.10± 3.56 mg, respectively; with P<0.001). Similarly, the frequency of paracetamol (1gm) intake was significantly lower in ESPB group than in the control group (P<0.001). |