Analgesic Efficacy of Ultrasound Guided Serratus Anterior Plane Block and Pectoral Nerve Block II Compared to Thoracic Epidural Block After Unilateral Modified Radical Mastectomy
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Anesthesia
- Sponsor
- Azhar University
- Enrollment
- 99
- Locations
- 1
- Primary Endpoint
- Measurement of Post-operative Pain
- Status
- Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
Modified Radical Mastectomy accounts for 31% of all breast surgeries and considered the fundamental surgical management for breast cancer. Nearly 40-60% of patients experience severe acute postoperative pain. This pain might persist for 6-12 months and result in post-mastectomy pain syndrome and complex regional pain syndrome (causalgia)
Detailed Description
There are some local or regional nerve blocks in breast surgeries performed as core components of multimodal analgesia and enhanced recovery after surgery (ERAS), including thoracic epidural (TEB), interscalene brachial plexus, paravertebral, ultrasound-guided pectoral nerve block ( PECS II ), ultrasound-guided serratus anterior plane block (SAPB) and erector spinae plane block . Thoracic epidural (TEB) is the gold standard technique following breast surgery, but there is still a problem with the adequacy of thoracic and axillary blockage during lymph node dissection . Modified PECS's block" or PECS block type II aimed to block the axilla that is vital for axillary clearances and the intercostal nerves, necessary for wide excisions which can provide analgesia after breast surgery. In the ultrasound-guided serratus anterior plane block (SAPB), the local anesthetic (LA) is injected in the compartment between the serratus anterior and latissimus dorsi muscles. SAPB anesthetizes the intercostobrachial nerve, lateral cutaneous branches of the intercostal nerves (T3-T9), long thoracic nerve, and thoracodorsal nerve thus providing analgesia for breast and lateral thoracic wall surgeries
Investigators
mohamed A Aboelsuod, MD
Assistant Professor of Anesthesia, intensive care and pain management Faculty of Medicine
Azhar University
Eligibility Criteria
Inclusion Criteria
- •Women aged 35-65 years.
- •BMI 18.5 - 25 kg/m
- •American Society of Anesthesiologists (ASA) I-II.
Exclusion Criteria
- •Patient refusal.
- •Coagulopathy.
- •Mental and psychiatric disorders.
- •History of chronic pain.
- •Hypersensitivity or contraindication to any of study drugs
- •Previous chemotherapy.
Outcomes
Primary Outcomes
Measurement of Post-operative Pain
Time Frame: First 24-hour analgesic after Mastectomy
Assessment of the pain post-operatively in patients with pain assessed by VAS score : Total scores vary from 0 to 10 in this method, with a higher score indicating more severe pain