Ultrasound, Pectoral Nerve Blocks, Thoracic Erector Spinae Plane Block, Serratus Anterior Plane Block, Breast Surgery
Conditions
Brief summary
The study will compare ultrasound-guided Pectoral nerve block, Erector Spinae Plane block, and Serratus anterior plane block for pain management following elective breast surgeries
Detailed description
Adequate acute postoperative pain control is important for patients undergoing breast surgery because the pain may be severe and longlasting. Surgical incision at the breast and axillary areas is associated with significant pain, with high incidence of acute pain progressing to chronic pain in 25% to 60% of patients. Post-mastectomy pain managed with opioids often lead to side effects of nausea and vomiting. Regional anesthetic techniques are used in the current management of pain associated with breast surgeries .They attenuate surgical stress response , intraoperative consumption of opioid, prevent central sensitization and diminish postoperative pain. The efficacy of fascial plane blocks like pectoral nerve block (PECS), serratus anterior plane block (SAP), and erector spinae plane block (ESP) has been proven in previous studies. These blocks require deposition of local anesthetic in an inter-fascial plane through which peripheral nerves travel. The Pectoral nerve block relies upon the deposition the local anesthetic at the inter-fascial planes among the pectoralis major, minor, and serratus anterior muscles: it blocks the pectoral, the intercostobrachial, the intercostals III and VI, and the long thoracic nerves. Erector Spinae Plane block is another interfacial plane block. It involves deposition of local anesthetic between erector spinae muscle and transverse process of T5 vertebrae and targets both dorsal and ventral rami of thoracic spinal nerves. Serratus anterior plane block involves the injection of local anesthetic in 1 of the 2 fascial planes, superficial and deep to serratus anterior muscle at the level of the fifth rib in midaxillary line. The SAP block targets the lateral cutaneous branches of the thoracic intercostal nerves. The deep SAP block was found to have similar analgesic efficacy and technically easier and safer to perform as compared to the superficial SAP block.
Interventions
DRUGPectoral nerve block (PECS)
Patients will receive pectoral nerve block (PECS).
Patients will receive erector spinae plane block (ESP).
Patients will receive serratus anterior plane block (SAP).
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
21 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
• Age from 21 to 65 years old female, American Society of Anesthesiologists (ASA) physical status I or II, who will undergo breast surgeries under general anesthesia.
Exclusion criteria
* Patient refusal to participate in research. * Body Mass Index (BMI) ≥35 kg/m2. * Sensitivity to the intervention drugs. * Coagulation abnormalities. * Psychiatric disorder and communication difficulties. * Chronic neurological disease. * Any skin infection at the needle puncture site. * Chest wall deformity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | Rescue analgesia of morphine will be given as 3 mg bolus if the visual analogue scale (VAS) ≥ 4 to be repeated after 30 min if pain persists until the VAS\< 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative fentanyl consumption | Intraoperatively | Intraoperative fentanyl consumption will be recorded.Additional fentanyl bolus dosages of 0.5 µg/kg IV will be administered if mean arterial blood pressure and heart rate elevated more than 20% of the baseline (after exclusion of other causes). |
| Pain degree | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the visual analogue scale (VAS) (20), from 0 to 10 (0 represents no pain while 10 represents the worst pain imaginable).Rescue analgesia of morphine will be given as 3 mg bolus if the VAS ≥ 4 to be repeated after 30 min if pain persists until the VAS\< 4. VAS will be assessed at 30min, 2, 6,12 and 24 h postoperatively |
| Mean arterial blood pressure | Till the end of surgery (Up to 24hours) | Intraoperative hemodynamic parameters: Mean arterial blood pressure (MAP) will be recorded at baseline, after performing of block, and every 15 min till the end of surgery. |
| Time to the 1st rescue analgesia | 24 hours postoperatively | Time to 1st request for the rescue of analgesia (time from the end of surgery till first dose of morphine administrated) will be recorded. |
| Patient satisfaction | 24 hours Postoperatively | Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied) |
| Adverse effects | 24 hours Postoperatively | bradycardia, hypotension, nausea, vomiting, respiratory depression, hematoma at the site of injection, local anesthetic toxicity will be recorded. |
| Heart rate | Till the end of surgery (Up to 24hours) | Intraoperative hemodynamic parameters: Heart rate (HR) will be recorded at baseline, after performing of block, and every 15 min till the end of surgery. |
Countries
Egypt
Contacts
Primary ContactRehab S Taha, Master
Outcome results
None listed