Arun Nidhi, Avinash Raja, Choudhary Annu
Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Cardiac Anaesthesia, Dr RML Hospital, ABVIMS, New Delhi, India.
Indian J Anaesth. 2024 Aug;68(8):686-692. doi: 10.4103/ija.ija_279_24. Epub 2024 Jul 2.
Nearly half of the patients following breast cancer surgery experience postoperative pain. The interfascial plane for the pectoral nerve (PECS) block, along with dexmedetomidine, can alleviate this pain.
After institutional ethics committee clearance and written informed consent, this randomised, double-blind study was conducted on 60, 18-60 years female patients, who were scheduled for modified radical mastectomy (MRM) under general anaesthesia. Patients were randomised into Group L (20 ml of 0.25% levobupivacaine) and Group DL (20 ml of 0.25% levobupivacaine with 0.5 µg/kg of dexmedetomidine). After resection of the tumour and securing haemostasis, under strict aseptic precaution, 10 ml of the study drug was injected under direct vision between the pectoralis major and pectoralis minor and 10 ml between pectoralis minor and serratus anterior muscles by the operating surgeon (direct PECS block). The primary outcome was to compare the duration of analgesia. Normally distributed variables were compared using Student's t-test, and non-normally distributed variables were compared using the Mann-Whitney U-test. Qualitative data were analysed using Chi-square/Fisher's exact test. Statistical significance was kept at < 0.05.
The median time of the first analgesic requirement was 8 [inter-quartile range (IQR): 6-8] h in Group L and 18 (IQR: 16-20) h in Group DL (W = 17.000, < 0.001). The mean total opioid consumption of Group L was 12.53 [standard deviation (SD): 2.29] mg in the first 24 h and 6.93 (SD: 1.89) mg in Group DL.
Adding 0.5 μg/kg dexmedetomidine to 20 ml of levobupivacaine enhances the duration of analgesia of direct PECS block in patients undergoing MRM.
近半数乳腺癌手术后患者会经历术后疼痛。胸神经（PECS）阻滞的筋膜间平面联合右美托咪定可缓解这种疼痛。
经机构伦理委员会批准并获得书面知情同意后，对60例年龄在18至60岁、计划在全身麻醉下行改良根治性乳房切除术（MRM）的女性患者进行了这项随机、双盲研究。患者被随机分为L组（20毫升0.25%左旋布比卡因）和DL组（20毫升含0.5微克/千克右美托咪定的0.25%左旋布比卡因）。肿瘤切除并止血后，在严格的无菌预防措施下，由手术医生在直视下于胸大肌和胸小肌之间注射10毫升研究药物，在胸小肌和前锯肌之间注射10毫升（直接PECS阻滞）。主要结局是比较镇痛持续时间。使用学生t检验比较正态分布变量，使用曼-惠特尼U检验比较非正态分布变量。定性数据采用卡方检验/费舍尔精确检验进行分析。统计学显著性设定为<0.05。
L组首次需要镇痛的中位时间为8[四分位间距（IQR）：6 - 8]小时，DL组为18（IQR：16 - 20）小时（W = 17.000，<0.001）。L组在前24小时的平均总阿片类药物消耗量为12.53[标准差（SD）：2.29]毫克，DL组为6.93（SD：1.89）毫克。
在20毫升左旋布比卡因中添加0.5微克/千克右美托咪定可延长接受MRM手术患者直接PECS阻滞的镇痛持续时间。
