الفهرس 
ANATOMY OF THE THORACIC WALL AND BREASTOnly 14 pages are availabe for public view
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Abstract
Recommendations:
In this study we injected 20 ml bupivacaine 0.25 in both PECS II and SAPB so we recommend to increase volume of bupivacaine injected in SAPB to be evaluated by further studies for achievinga adequate spread and clinical effect.
In this study SAPB was done where bupivacaine was injected superficial to serratus anterior so further studies will be required to assess efficacy of this block if done in deeper plane by injecting bupivacaine deep to serratus anterior.
In our study we assessed the efficacy of both blocks in postoperative pain management for the first 24 hours (acute pain). Further studies are required to assess efficacy of both blocks on chronic pain after MRM as there is high risk of persistence of post mastectomy pain syndrome (PMPs) which is defined as chronic neuropathic pain continuing for 3 months or more affecting axilla medial arm, breast and chest wall after surgery.
CONCLUSION
O
ur findings suggest that PECS II block is more effective regarding postoperative pain control in patients undergoing modified radical mastectomy under general anesthesia compared to SAPB especially in the first 16 hours postoperative. Also patients underwent PECS II block show less need to intraoperative fentanyl incremental doses, less need to postoperative opioids and longer duration for time of rescue analgesia compared to patients underwent SAPB.
SUMMARY
B
reast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women.
A procedure called Modified radical mastectomy is now a standard surgical treatment for early stage breast cancers. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases.
Though various risk factors have been suggested, inappropriate acute postoperative pain management has been associated with the development of chronic post-mastectomy pain, a complex post-surgical pain syndrome that may occur following any type of breast surgery.
After the application of ultrasound in anesthetic practice, several interfacial plane blocks have been described. The PECS I block involves a hydrodissection of the plane between the pectoral muscles with local anesthetic to block the lateral and medial pectoral nerves, and PECS II nerve block which is an extension that involves a second injection lateral to the Pecs I injection point in the plane between the pectoralis minor and serratus anterior muscles with the intention of providing blockade of the upper intercostal nerves.
Serratus anterior plane block is performed at the axillary fossa, in which the intercostobrachialis nerve, lateral cutaneous branches of the intercostal nerves (T3–T9), long thoracic nerve, and thoracodorsal nerve are located in a compartment between the serratus anterior and the latissimus dorsi muscles, between the posterior and midaxillary lines (Blanco, 2011).
The aim of this work is to evaluate the efficacy of ultrasound guided pectoral nerve block type two versus Serratus Anterior plane block regarding postoperative pain control in patients undergoing modified radical mastectomy.
After obtaining approval from the medical ethical committee in Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospitals. It included 70 female patients undergoing modified radical mastectomy were divided randomly into two groups, each group consisted of 35 patients; group I patients received pectoral nerve block type two (PECS II), group II patients received Serratus Anterior Plane Block (SAPB).
The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue score, time of rescue analgesia and total consumption of opioid in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed.
The results of our study showed that there was no statistically significant difference between groups regarding demographic data.
Also, there was a statistically significant decrease in Mean blood pressure (mmHg) in group I compared with group II from hour-4 to hour-16 postoperative.
However, a statistically significant decrease in group I compared to group II regarding postoperative heart rate (beat/min) from hour-4 to hour-16.
A statistically significant decrease in group I compared to group II regarding visual analogue score for pain from minute-30 to after 12 hrs also was found.
The current study shows highly statistically significant difference between groups as regard the need to intraoperative fentanyl incremental doses, time of first rescue analgesia, number of patients who received postoperative pethidine and total dose of opioids during the first 24 hrs.