Department of Anaesthesiology & Critical Care, Vivekananda Institute of Medical Sciences, 99, Sarat Bose Road, Kolkata 700026, West Bengal, India.
Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry 605006, India.
Br J Anaesth. 2017 Oct 1;119(4):830-835. doi: 10.1093/bja/aex201.
Pectoral nerve block1 (PEC1) given between pectoralis major and minor, and modified pectoral nerve block2 (mPEC2) performed between pectoralis minor and serratus anterior, can provide continuous analgesia after modified radical mastectomy (MRM) when catheters are placed before skin closure. This study was designed to compare PEC1 and mPEC2 block for providing postoperative pain relief after MRM.
Sixty-two physically fit patients undergoing MRM were assigned into two groups (Group PEC1, n=31 and Group mPEC2, n=31). Before wound closure, epidural catheter was placed in the group designated muscle plane and 30ml of 0.25% bupivacaine was injected through the catheter after wound closure. Bupivacaine 15ml of 0.25% top up was given on patient's demand or whenever visual analogue scale (VAS) score was>4. Time for first analgesia (TFA), number of top ups and VAS was recorded at 0.5, 6, 12, 18, 24 h after surgery. Sensory blockade was assessed 30 min after extubation.
Analgesia was significantly prolonged in group mPEC2 [mean(SD)] 313.45(43.05) vs 258.87(34.71) min in group PEC1, P<0.001. Total pain experienced over 24 h was significantly less in group mPEC2 [mean(SD)] 9.77(6.93) than in group PEC1 24.19(10.81), P<0.0001. Consequently, top up requirements were significantly reduced in group mPEC2 than in group PEC1 [median(range)] 3(2-4) vs 4(3-5) respectively, P<0.001. Lateral pectoral (77.42% and 35.48%) and thoracodorsal nerves (93.55% and 48.39%) had higher incidence of sensory block in group mPEC2 than group PEC1, P<0.001.
mPEC2 provides better postoperative analgesia than PEC1 when catheters are placed under direct vision after MRM.
CTRI/2017/02/007811 (REF/2015/11/010185).
胸大肌和胸小肌之间的胸神经阻滞 1（PEC1）和胸小肌与前锯肌之间的改良胸神经阻滞 2（mPEC2），在改良根治性乳房切除术（MRM）前放置导管时，可在手术后提供连续镇痛。本研究旨在比较 PEC1 和 mPEC2 阻滞在 MRM 后的术后疼痛缓解效果。
62 名体格健康的接受 MRM 的患者被分为两组（PEC1 组，n=31 和 mPEC2 组，n=31）。在伤口关闭之前，在指定的肌肉平面中放置硬膜外导管，在伤口关闭后通过导管注入 30ml0.25%布比卡因。当视觉模拟评分（VAS）>4 时，根据患者需求或每隔 15ml 给予 0.25%布比卡因追加剂量。在手术后 0.5、6、12、18 和 24 小时记录首次镇痛时间（TFA）、追加次数和 VAS。在拔管后 30 分钟评估感觉阻滞情况。
mPEC2 组的镇痛时间明显延长[中位数（SD）]313.45（43.05）比 PEC1 组 258.87（34.71），P<0.001。mPEC2 组 24 小时内总疼痛评分明显低于 PEC1 组[中位数（SD）]9.77（6.93）比 24.19（10.81），P<0.0001。因此，mPEC2 组的追加需求明显低于 PEC1 组[中位数（范围）]3（2-4）比 4（3-5），P<0.001。mPEC2 组的外侧胸肌（77.42%和 35.48%）和胸背神经（93.55%和 48.39%）感觉阻滞发生率高于 PEC1 组，P<0.001。
在 MRM 后直接放置导管时，mPEC2 比 PEC1 提供更好的术后镇痛效果。
CTRI/2017/02/007811（REF/2015/11/010185）。
