الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 116 |  |  |
| | | from | 116 | | |
Abstract
Pain is an unpleasant sensory and emotional human experience; perioperative pain is even more distressing to the patient. Inadequate relief of acute postoperative pain can lead to the development of chronic pain syndromes, which can cause disabilities and interfere with daily activities.
Preemptive analgesia in mastectomy patients leads to speedy recovery, early mobilisation and lower incidence of post-operative pulmonary morbidity.
Regional nerve blocks can be a good alternative or a useful adjuvant to systemic analgesics in patients undergoing breast surgeries. Paravertebral nerve blockade, by injecting local anesthetic solution into the paravertebral space, produces ipsilateral analgesia and has been advocated mainly in unilateral surgeries like thoracotomy, chest wall, breast and renal surgeries. Serratus plane block, which involves depositing LA in the plane superficial or deep to the serratus anterior muscle, has been suggested to provide analgesia in similar surgeries involving the breast and hemithorax.
The aim of this work was to compare the intensity and duration of analgesia provided by the two blocks, as well as the safety and applicability of the two techniques.
The present study was carried out on 40 adult female patients aged 20-60 years, ASA physical status class II and III, admitted to “Alexandria Main University hospital” for elective unilateral mastectomy.
Patients were excluded upon refusal of the regional block or inability to properly describe postoperative pain to the observer, or when the patient presented with coagulopathy, preoperative history of opioid addiction, allergy or contraindication to the studied anaesthetic agents, infection at the site of LA injection, prior breast surgery except for diagnostic biopsies, and morbid obesity.
Patients were divided into two equal groups (twenty patients each) in a randomised manner using the closed envelope method:
group 1 (PVPB): Patients received combined general anaesthesia and ultrasound guided thoracic paravertebral plane block.
group 2 (SAPB): Patients received combined general anaesthesia and ultrasound guided serratus anterior plane block.
Evaluation of patients was carried out through proper history taking, thorough clinical examination and all needed laboratory investigations (including a complete blood count and a coagulation profile). Before surgery, the participants received education about the VAS pain score and the details of the nerve block procedures.
Induction of anaesthesia was done using IV fentanyl (1-2 µg/kg) and propofol (2-2.5 mg/kg) injected slowly till loss of verbal communication and atracurium (0.5 mg/kg) IV to facilitate endotracheal intubation.
Isoflurane (1.2−1.5%) in 100% oxygen and incremental doses of atracurium (0.1 mg/kg) were given every 20-30 minutes to maintain anaesthesia.
The ultrasound guided block was performed for all patients after induction of general anaesthesia and prior to the surgical incision. Patients were divided into two groups according to the method of analgesia provided.
A parenteral injection of ketorolac 30 mg was administered 10 min before the end of the procedure. At the end of surgery, after extubation, the patients were transferred to the PACU.