الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common cancer in women, it is about (39%) of all types of cancer affecting female in Egypt. Postoperative pain is one of the greatest patient concerns following any surgery. Although an increased emphasis has been placed on pain management, approximately 80% of surgical patients report postoperative Pain with 86% of patients rating their pain as moderate, severe, or extreme.
Patients undergoing breast surgery require a multimodal postoperative pain treatment regimen that provides high quality analgesia with minimal side effects. Until now, oncologic breast surgeries are typically performed by general anesthesia. However, general anesthesia cannot provide adeguate postoperative pain control and routine use of parenteral opoids aggrevate postoperative sedation, nausea, emesis, impaired oxygenation and decrease ventilation. Many studies have been carried out trying to find a solution for these dilemma thus different analgesic modalities as local infilteration of surgical field, systemic analgesia, neuro-axial blocks, and nerve blocks.
Thoracic Epidural Analgesia and paravertebral blocks became the gold standard to achieve postoperative pain relief afer breast surgery, but not every anaesthiologist is comfortable performing these procedures. As an alternative for these technigues Serratus anterior plane block was designed.
SAPB involves depositing LA in the plane superficial or deep to the serratus anterior muscle, and has been suggested to provide analgesia in similar surgeries involving the breast and hemithorax.
The primary aim of this study was to compare between the efficiency of serratus anterior plane block and thoracic epidural analgesia in terms of postoperative pain relief in the 1st 24 hours determined by VAS score.
The secondary aim was to compare between the two methods as regards duration of the procedure in minutes, incidence of adverse effects, total analgesic consumption in the 1st 24 hours and patient satisfaction.
The present study was carried out in Alexandria Main University hospitals on 40 female patients aged 25-50 years old, American Society Of Anesthesiologists (ASA) class II or III scheduled for elective unilateral modified radical mastectomy.
Exclusion criteria:
• History of allergy or contraindication to any of the studied drugs.
• Patient refusal.
• Skin infection at the site of injection.
• Bleeding disorders or receiving anticoagulant.
• Spine or chest wall deformity.
• Body mass index more than 35 kg/m2.
Patients were randomly categorized using closed envelope technique into two equal groups (20 patients each group):
group E: Epidural catheter will be inserted at T4-T5 after the induction of general anaesthesia.
group S: Patients will receive ultrasound guided Serratus anterior plane block after induction of general anaesthesia.
The following parameters were measured:
1. Vital signs: Heart rate, Systolic blood pressure, oxygen saturation and end tidal CO2 were recorded preoperative, after block, after induction of anesthesia, at skin incision, then every 10 min till the end of the surgery and then 0, 2, 4, 6, 12, 24 hours postoperatively.
2. Pain Score at rest and during coughing: Pain will be assessed immediately after full recovery from general anaesthesia and at 2, 4, 6, 12 and 24 hours postoperative.
3. Total dose of given rescue analgesia: in the form of nalbuphine, as well as the timing of the first rescue analgesic dose given.
4. Postoperative complications: Such as Hypotension, Nausea and vomiting, Urine retention, Hematoma at site of injection, etc.
5. Patient satisfaction: Satisfaction score (Excellent, Good, Fair, Poor)
The following data was obtained:
• There was an insignificant statistical difference in HR and SBP between TEA and SAPB intraoperatively and postoperative up to 12 hours, then there was a statistically significant increase in the BP in group S than group E.
• Comparison between the two studied groups using p value showed that there was a significant increase in VAS at 12h, 24h postoperative in group S than group E.
• Comparing the two groups regarding Total dose of nalbuphine given for each patient there was a significant increase in total dose of nalbuphine in group A than in group B with p value=0.001.
• Comparing the two groups regarding Time to first analgesic requirement postoperatively shows a statistically significant longer latency period before starting the analgesia regimen in group E than in group E with p value 0.040.
• Comparing the two groups regarding patient satisfaction there was no statistically significant difference between the 2 groups with p=0.285