Breast Surgery
Conditions
Keywords
Pectoral nerve block, Adenosine, Magnesium sulphate
Brief summary
Pectoral nerve block (PECS) has been used for post-operative pain relief in patients undergoing breast surgery. It has been shown that adenosine has an effect on pain modulation. Magnesium sulphate has been used as an adjuvant to local anaesthetics in many nerve block techniques. We hypothesised that adenosine may affect the PECS block quality. We aimed to compare the effect of adding adenosine to the local anaesthetic and compare its effect to magnesium sulphate when used for PECS block.
Detailed description
The present study was conducted on 90 adult patients aged between 20 and 65 years old. Patients scheduled for modified radical mastectomy with axillary clearance surgery American Society of Anaesthetist (ASA) classes I, II, and III patients were included in the study. Patients were randomly allocated into on of three groups according to the adjuvant used with the local anaesthetic, 30 patients in each group using a computerised program. All patients received PECS block. Group (C) received PECS block with 0.25% bupivacaine (control group), group (A) bupivacaine with added adenosine, and group (M) bupivacaine with added magnesium sulphate. The local anaesthetic syringes were prepared by an independent anaesthetist. The researchers and the patients were blinded to the local anaesthetic adjuvant in the syringes. All patients received 30 ml local anaesthetic for PECS. The 30 ml local anaesthetic used for each patient contained bupivacaine hydrochloride 0.25%, bupivacaine hydrochloride 0.25% and 12 mg adenosine, and bupivacaine hydrochloride 0.25% and 500 mg magnesium sulphate for groups C, A, and M respectively. Patients' demographic data were collected including age, BMI, ASA, and duration of surgery. In the post- anesthetic care unit (PACU) the visual analogue score (VAS) was assessed on arrival and then every 15 minutes. The duration and the quality of the block was recorded.
Interventions
DRUGBupivacaine 0.25%
Bupivacaine 0.25% for PECS block
DRUGAdenosine 12mg
Adenosine 12 mg for PECS block
Magnesium sulphate 500 mg for PECS block
Sponsors
Menoufia University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for modified radical mastectomy with axillary clearance surgery ASA classes I, II, and III patients were included in the study
Exclusion criteria
* 1\) contraindications for regional anesthesia such as coagulopathy, local infection and fungating breast cancer, 2) history of allergy to the medications used in the study, 3) patient with history of drug abuse, 4) previous breast surgery except for diagnostic biopsies, 5) history of treatment for a chronic pain condition, 6) psychiatric disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual analogue scale (VAS) | First 24 hours after surgery | Visual analogue scale is a scale from 1 to 10 where 1 is no pain and 10 is the worst pain the patient experienced. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Analgesic requirement | First 24 hours after surgery | The total amount of morphine (mg) consumed by patients. |
| PECS block duration. | First 24 hours after surgery | The time from performing the block until the patient started to feel pain and the effect of the block faded. |
| Mean arterial blood pressure (mmHg) | Intra-operative (from induction of anaesthesia until the patient is awake) | Mean arterial blood pressure reading. |
| Heart rate (beat/minute) | Intra-operative(from induction of anaesthesia until the patient is awake) | The number of hear beats per minute |
Outcome results
None listed