الفهرس 
A--Anattomy off breasttOnly 14 pages are availabe for public view
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Abstract
Summary and concllusiion
Breast Cancer is the most commonly occurring cancer affecting
women, causing acute pain, and in high percentage of patients, it progress to
chronic pain syndromes. Thoracic epidural block have been used to provide
analgesia for breast surgeries.
Modified pectoralis block and serratus plane block are novel options
of regional anaesthesia that can produce reliable analgesia without the
potential risks of neuraxial block.
In this study we aimed to evaluate the analgesic efficacy of single shot
thoracic epidural block, ultrasound guided modified pectoralis block and
serratus anterior plane block for patients underwent breast surgery.
This prospective randomized study was carried out in Tanta
University Hospital General Surgery Department after approval from ethical
committee and informed consent describing benefits and hazards of the
technique. The study included 90 adult female patients aged 20 - 65 years,
ASA class I &II scheduled for elective breast surgery.
Exclusion criteria included, patient refusal, past history of coagulation
disorders, spine or chest wall deformity, uncontrolled chronic medical
disease e.g (renal or hepatic failure), patients on opioid treatment, obese
patients with body mass index (BMI) ≥ 30, known allergy to local
anaesthetics or opioid, infection at the block site, coagulopathy and
uncooperative patients
Patients were allocated randomly into three groups either thoracic
epidural group, modified pectoralis group, or serratus anterior plane group.Three blocks were performed in the operating room before induction of
anaesthesia under complete aseptic techniques and standard monitor.
group I (thoracic epidural block) patients received 7 ml bupivacaine
0.25%. group II (modified pectoralis block) patients received 10 ml
bupivacaine between pectoralis minor muscle and pectoralis major muscle
and 20 ml bupivacaine 0.25% between pectoralis minor and serratus anterior
muscle. group III (serratus anterior plane block) patients received 40 ml
bupivacaine 0.25% between latissmus dorsi muscle and serratus anterior
muscle at 5th rib in mid clavicular line.
The demographic data the three studied groups including age, weight
and type and duration of operation, were comparable.
Regarding hemodynamic parameter our results revealed insignificant
changes in heart rate among the three studied groups at base line, after block
and after induction. Also we found statistically significant decrease in heart
rate in group I (TEB) compared to group II (Pecs) and III (SPB). Moreover
there was statistically significant decrease in heart rate in group III compared
to group II. While there was no statistically significant difference in mean
arterial blood pressure among three studied groups during all intra and postoperative
periods.
As regard the intraoperative fentanyl consumption in our study there
was no significant difference among three groups as regard total dose of
fentanyl consumption.
Concerning VAS pain score; which considered primary outcome; at rest
and during cough our result revealed, no significant changes among three
groups at 1 hour. Then VAS decreased significantly in group I (thoracic
epidural) and group III (serrratus block) compared to group II (modified pectoralis) from 3-24 hours post-operatively, while there was no significant
difference between group I and III.
As regard duration of analgesia; which considered secondary outcome;
our results showed no significant difference between group I (thoracic
epidural) and group II (modified pectoralis), and there was significantly
longer duration of post-operative analgesia in group III (serratus block)
compared to group I & II.
Regarding rescue analgesia (morphine) required during 24 hours postoperatively,
our results showed that there was no statistically significant
difference between group I & II, while there was statistically significant
smaller dose of rescue analgesia required in group III compared to group I & II
Concerning complications in our study, there was no statistically
significant difference among three groups as regard intra-operative and postoperative
complications.
Concllusiion
from the results of the present study, we can conclude that serratus
anterior plane block provided better analgesia as indicated by longer duration
of analgesia and lower doses of post-operative morphine consumption
compared to thoracic epidural block and modified pectoralis block.
Limitation
There was a limited amount of objective data regarding the comparison
among the three studied blocks. Also, the small number of patients used in
our study is another limitation.
Recommendations
Although, there was a few studies about the comparison among the
three studied groups, so further prospective studies should be performed to
overcome these limitations and to confirm our results.