Abstract:
Objective To evaluate the analgesic efficacy of combining ultrasound-guided pectoral nerves block Ⅱ (PECSⅡ) with transverse thoracic muscle plane (TTMP) block in breast cancer patients undergoing prosthetic breast reconstruction after radical mastectomy for stage I breast cancer.
Methods Sixty patients who underwent elective unilateral prosthetic breast reconstruction after radical mastectomy for stage I breast cancer between March 2022 and January 2023 at Tianjin Medical University Cancer Institute & Hospital were enrolled in this study. They were randomly assigned into two groups: Group C, consisting of 30 patients who received general anesthesia; and Group P, consisting of 30 patients who received general anesthesia combined with PECSⅡ and TTMP block. In Group C, patients received conventional anesthesia induction; Group P patients underwent ultrasound-guided PECSⅡ and TTMP block after anesthesia induction. A visual analog scale (VAS) was used to assess the intensity of pain at rest and during coughing movements at 1, 6, 12, and 24 h after surgery. The total consumption and adverse reactions of opioids during the perioperative period were recorded. The levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF-α) were measured before the induction of anesthesia, at the end of surgery, as well as 12 and 24 h after surgery. The 15-item quality of recovery (QoR-15) scale was assessed at 24 h postoperatively.
Results Group P demonstrated significantly lower VAS scores than Group C at rest and during coughing exercises at 1, 6, and 12 h postoperatively (P<0.001). There was no significant difference between the two groups in VAS scores during rest at 24 h postoperatively (P=0.198); however, the scores were significantly lower in group P than in group C during coughing exercises (P<0.05). Total fentanyl consumption at 24 h postoperatively was significantly lower in group P (240.97±18.76) μg than that in group C (318.37±22.63) μg (P<0.001). Serum IL-1β, IL-6, and TNF-α levels at the end of surgery, 12 h postoperatively, and 24 h postoperatively were significantly lower in group P than in group C (P<0.001). The QoR-15 score was significantly higher in group P (136.63±4.41) than in group C (130.13±3.52) at 24 h postoperatively (P<0.001).
Conclusions Compared with general anesthesia alone, combined ultrasound-guided PECSII and TTMP with general anesthesia significantly reduces pain intensity and inflammatory factor levels 24 h following prosthetic breast reconstruction after radical mastectomy for stage I breast cancer. Moreover, patients require less perioperative opioid dosage and have better recovery.
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