|Table of Contents|

Analysis of the effects of local anesthetics in combination with anterior serratus block and thoracic nerve block during the perioperative phase of radical mastectomy in elderly patients

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 08
Page:
1506-1512
Research Field:
Publishing date:

Info

Title:
Analysis of the effects of local anesthetics in combination with anterior serratus block and thoracic nerve block during the perioperative phase of radical mastectomy in elderly patients
Author(s):
ZENG Jianqiang; YUAN Lei; ZHONG Zhaoying; PENG Donglan; SONG Caihong
Ganzhou City Cancer Hospital，Jiangxi Ganzhou 341000,China.
Keywords:
lidocaine; ropivacaine; serratus anterior; thoracic nerve; nerve conduction block; radical mastectomy for breast cancer; anesthesia and analgesia
PACS:
R737.9
DOI:
10.3969/j.issn.1672-4992.2024.08.024
Abstract:
Objective:To investigate the effect of lidocaine and ropivacaine serratus plane block (SPB) combined with thoracic nerve block (PECS) in the perioperative period of radical mastectomy for elderly patients with breast cancer.Methods:Ninety-two elderly patients undergoing radical mastectomy in our hospital from January 2020 to January 2022 were retrospectively selected and divided into general anesthesia group (n=30),ropivacaine SPB+PECS+general anesthesia (n=31),and lidocaine SPB+PECS+general anesthesia (n=31) by random number table method.To observe and record the average arterial pressure (MAP) and heart rate (HR) of the patient 30 minutes before surgery (T0),after nerve block (T1),after anesthesia induction (T2),15 minutes after surgery (T3),10 minutes before surgery (T4),and 15 minutes after awakening (T5).Record the visual analogue scale (VAS) of patients entering the anesthesia and resuscitation room (PACU) and at 4,12,24,and 48 hours after surgery.To detect the levels of serum inflammatory factors such as tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),and hypersensitive C-reactive protein (hs-CRP) in patients before surgery,4 hours after surgery,1 day,3 days,and 7 days after surgery.To record the patient's time of tracheal catheter removal,recovery time,and intraoperative dosage of sufentanil and propofol.To record the patient's relief and pain relief situation within 48 hours after surgery,the number of effective compressions of the pain relief pump,and the amount of sufentanil used,and record adverse reactions such as respiratory suppression,bradycardia,skin itching,nausea and vomiting within 48 hours after surgery,as well as the occurrence of delirium 7 days after surgery.Results:There were significant differences in the levels of MAP,HR,VAS,TNF-α,IL-6,and hs-CRP indicators among the three groups of patients at various time points (P＜0.05).Compared with the general anesthesia group,the ropivacaine and lidocaine groups had significantly lower MAP indicators at T3 after anesthesia (P＜0.05),significantly lower HR indicators at T1 and T3 after anesthesia (P＜0.05),and significantly decreased VAS indicators at 12,24,and 48 hours after surgery (P＜0.05).The levels of TNF-α,IL-6 and hs-CRP indicators also showed a significant decrease (P＜0.05).At the same time,the VAS pain score of patients in the lidocaine group was significantly lower than that in the ropivacaine group at 12 h,24 h,and 48 h after surgery (P＜0.05),while the hs-CRP index of patients in the lidocaine group decreased significantly at 4 h,1 d,and 3 d after surgery compared to the ropivacaine group (P＜0.05).Compared with the general anesthesia group,patients in the ropivacaine group and lidocaine group had lower tracheal catheter removal time,recovery time,and intraoperative sufentanil and propofol dosage (P＜0.05).The postoperative dosage of sufentanil in the ropivacaine and lidocaine groups was significantly lower than that in the general anesthesia group (P＜0.05),and the duration of analgesia was significantly longer than that in the general anesthesia group (P＜0.05).Additionally,the postoperative dosage of sufentanil in the lidocaine group was lower than that in the ropivacaine group (P＜0.05),and the duration of analgesia was longer (P＜0.05).There were significant differences in the incidence of postoperative respiratory depression,bradycardia,skin itching,nausea and vomiting,and postoperative delirium among the three groups of patients (P＜0.05).Conclusion:Compared with general general anesthesia,local anesthesia SPB+PECS+general anesthesia is more effective in radical mastectomy for elderly breast cancer,which helps to reduce the use of opioids,reduce postoperative pain and postoperative inflammatory stress,and prolong the analgesic time,to promote early postoperative recovery of patients,and compound lidocaine is more effective than ropivacaine,and its postoperative analgesic effect is better.

References:

［1］ SUNG H,FERLAY J,SIEGEL RL,et al.Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries［J］.CA Cancer J Clin,2021,71(3):209-249.
［2］ KATSURA C,OGUNMWONYI I,KANKAM HK,et al.Breast cancer:presentation,investigation and management［J］.Br J Hosp Med (Lond),2022,83(2):1-7.
［3］ KUJAWA E,BLAU A,RAMETTA L.Anesthesia related to breast cancer recurrence and chronic pain:a review of current research［J］.Aana J,2021,89(4):291-298.
［4］ ALBI-FELDZER A,DUREAU S,GHIMOUZ A,et al.Preoperative paravertebral block and chronic pain after breast cancer surgery:a double-blind randomized trial［J］.Anesthesiology,2021,135(6):1091-1103.
［5］ 刘梦菲,何龙,田丹丹,等.艾司氯胺酮复合右美托咪定行无阿片麻醉对乳腺癌改良根治术患者术后恢复质量的影响［J］.郑州大学学报(医学版),2023,58(03):363-366. LIU MF,HE L,TIAN DD,et al.Effect of opioid-free anesthesia with esketamine combined with dexmedetomidine on postoperative recovery quality in patients with modified radical resection of breast cancer ［J］.Journal of Zhengzhou University (Medical Science Edition),2023,58(03):363-366.
［6］ 袁伟,李岩松,许刚,等.超声引导下的Ⅱ型胸神经阻滞复合改良的前锯肌阻滞对乳腺癌患者术后康复的应用价值［J］.现代肿瘤医学,2022,30(01):125-129. YUAN W,LI YS,XU G,et al.Application value of ultrasound-guided type II thoracic nerve block combined with improved serratus anterior plane block in postoperative rehabilitation of breast cancer patients ［J］.Modern Oncology，2022,30(01):125-129.
［7］ KAUR H,ARORA P,SINGH G,et al.Dexmedetomidine as an adjunctive analgesic to ropivacaine in pectoral nerve block in oncological breast surgery:A randomized double-blind prospective study［J］.J Anaesthesiol Clin Pharmacol,2017,33(4):457-461.
［8］ BRUMANA MB,MILANI M,PUVIANI M.Efficacy of lidocaine 7%,tetracaine 7% self-occlusive cream in reducing MAL-cPDT-associated pain in subjects with actinic keratosis:A randomized,single-blind,vehicle-controlled trial (The "3P-Trial")［J］.Photodiagnosis Photodyn Ther,2020,30:101758.
［9］ REED MD,VAN NOSTRAN W.Assessing pain intensity with the visual analog scale:a plea for uniformity［J］.J Clin Pharmacol,2014,54(3):241-244.
［10］ GUSMAO-FLORES D,SALLUH JI,CHALHUB R,et al.The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium:a systematic review and meta-analysis of clinical studies［J］.Crit Care,2012,16(4):R115.
［11］ WANG K,YEE C,TAM S,et al.Prevalence of pain in patients with breast cancer post-treatment:A systematic review［J］.Breast,2018,42:113-127.
［12］ 李喜龙,任柏林,乔迎帅,等.艾司氯胺酮用于乳腺癌改良根治术老年患者术后自控静脉镇痛的效果［J］.中华麻醉学杂志,2022,42(02):181-185. LI XL,REN BL,QIAO YS,et al.Effect of esketamine on self-controlled intravenous analgesia in elderly patients after modified radical breast cancer surgery ［J］.Chinese Journal of Anesthesiology,2022,42(02):181-185.
［13］ 中华医学会麻醉学分会老年人麻醉与围术期管理学组，中华医学会麻醉学分会疼痛学组国家老年疾病临床医学研究中心，国家老年麻醉联盟.老年患者围手术期多模式镇痛低阿片方案中国专家共识(2021版)［J］.中华医学杂志,2021,101(03):170-184. The Elderly Anesthesia and Perioperative Management Group of the Anesthesiology Branch of the Chinese Medical Association,the Pain Group of the Anesthesiology Branch of the Chinese Medical Association,the National Clinical Medical Research Center for Geriatric Diseases,the National Elderly Anesthesia Alliance.Chinese Expert Consensus on perioperative multimodal analgesia and low opioid in elderly patients(2021edition)［J］.Chinese Medical Journal,2021,101(03):170-184.
［14］ FINNERTY DT,MCMAHON A,MCNAMARA JR,et al.Comparing erector spinae plane block with serratus anterior plane block for minimally invasive thoracic surgery:a randomised clinical trial［J］.Br J Anaesth,2020,125(5):802-810.
［15］ GUERRA-LONDONO CE,PRIVOROTSKIY A,COZOWICZ C,et al.Assessment of intercostal nerve block analgesia for thoracic surgery:A systematic review and meta-analysis［J］.JAMA Netw Open,2021,4(11):e2133394.
［16］ 邓城旗,王凯元,王桂月,等.Ⅱ型胸神经联合胸横肌平面阻滞在乳腺癌根治Ⅰ期假体乳房重建术后镇痛的应用［J］.中国肿瘤临床,2023,50(12):612-615. DENG CQ,WANG KY,WANG GY,et al.Application of type II thoracic nerve combined with transverse thoracic muscle plane block in analgesia after stage I prosthesis reconstruction for radical breast cancer ［J］.Chinese Oncology,2023,50(12):612-615.
［17］ BORTOLOTTI P,FAURE E,KIPNIS E.Inflammasomes in tissue damages and immune disorders after trauma［J］.Front Immunol,2018,9:1900.
［18］ SINGH R,NARANG M,DAWSON L,et al.Could disease severity and inflammatory markers (IL-6,Hs-CRP,TNF-α) be related to frailty in COPD? A prospective study［J］.J Assoc Physicians India,2022,70(4):11-12.
［19］ HU Z,DENG N,LIU K,et al.CNTF-STAT3-IL-6 axis mediates neuroinflammatory cascade across schwann cell-neuron-microglia［J］.Cell Rep,2020,31(7):107657.
［20］ SU BJ,DONG Y,TAN CC,et al.Elevated Hs-CRP levels are associated with higher risk of intracranial arterial stenosis［J］.Neurotox Res,2020,37(2):425-432.
［21］ 张卓,张麟临,马浩南,等.乳腺癌改良根治术麻醉的优化策略：复方利多卡因胸横肌平面阻滞-胸神经阻滞-全身麻醉［J］.中华麻醉学杂志,2022,42(03):298-301. ZHANG Z,ZHANG LL,MA HN,et al.The optimal anesthesia strategy for modified radical mastectomy of breast cancer:compound lidocaine transversal plane block,thoracic nerve block and general anesthesia ［J］.Chinese Journal of Anesthesiology,2022,42(03):298-301.

Memo

Memo:
江西省卫生健康委科技计划项目（编号：202212547）
Last Update: 1900-01-01