Othman Ahmed H, El-Rahman Ahmad M Abd, El Sherif Fatma
South Egypt Cancer Institute, Assuit University, Assuit, Egypt.
Department of Anesthesia, Intensive Care, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egyp.
Pain Physician. 2016 Sep-Oct;19(7):485-94.
Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries.
This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery.
A randomized, double-blind, prospective study.
Academic medical center.
This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 - 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine plus ketamine hydrochloride (1 mg/kg). Patients were followed up for 48 hours postoperatively for vital signs, VAS score, first request of rescue analgesia and total morphine consumption, sedation score, and side effects.
Ketamine plus bupivacaine in Pecs block compared to bupivacaine alone prolonged the mean time of first request of analgesia (18.25 ± 1.98), (12.56 ± 2.64), respectively (P < 0.001), reduced total morphine consumption (12.50 ± 4.63), (18.86 ± 6.28), respectively (P = 0.016). With no significant difference in hemodynamics, respiratory rate, oxygen saturation, VAS and sedation scores, and side effects observed between the 2 groups (P > 0.05).
This study is limited by its sample size.
The addition of ketamine to modified Pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients who underwent a modified radical mastectomy.
Ketamine, bupivacaine, pecs block, postoperative, pain, breast cancer.
乳房手术是一种极为常见的手术，急慢性疼痛的发生率呈上升趋势。胸肌神经阻滞是一种新型的外周神经阻滞方法，可替代神经轴索阻滞和椎旁阻滞用于门诊乳房手术。
本研究旨在比较在接受乳腺癌手术的患者中，氯胺酮加布比卡因改良胸肌阻滞与布比卡因的镇痛效果和安全性。
一项随机、双盲、前瞻性研究。
学术医疗中心。
本研究经埃及阿斯尤特大学阿斯尤特南埃及癌症研究所伦理委员会批准后，在www.clinicaltrials.gov上注册，注册号为（NCT02620371）。纳入60例计划行改良根治性乳房切除术的18至60岁患者，并随机分为2组（每组30例）：对照组患者仅接受超声引导下30 mL 0.25%布比卡因的胸肌阻滞。氯胺酮组患者接受超声引导下30 mL 0.25%布比卡因加盐酸氯胺酮（1 mg/kg）的胸肌阻滞。术后对患者进行48小时随访，观察生命体征、视觉模拟评分（VAS）、首次要求使用解救镇痛药的时间和吗啡总用量、镇静评分及副作用。
与单独使用布比卡因相比，胸肌阻滞中氯胺酮加布比卡因延长了首次要求镇痛的平均时间，分别为（18.25±1.98）和（12.56±2.64）（P<0.001），减少了吗啡总用量，分别为（12.50±4.63）和（18.86±6.28）（P = 0.016）。两组间血流动力学、呼吸频率、血氧饱和度、VAS评分和镇静评分以及副作用均无显著差异（P>0.05）。
本研究受样本量限制。
在改良根治性乳房切除术患者中，改良胸肌阻滞加用氯胺酮可延长首次要求镇痛的时间并减少阿片类药物总用量，且无严重副作用。
氯胺酮；布比卡因；胸肌阻滞；术后；疼痛；乳腺癌
