Efficacy of combination of anterior cutaneous branch of intercostal nerve block and pectoral nerves block type II for early postoperative analgesia in patients undergoing modified radical mastectomy: a comparison with pectoral nerves block type II

Objective To evaluate the efficacy of anterior cutaneous branch of the intercostal nerve block combined with pectoral nerves (Pecs) block type Ⅱ for early postoperative analgesia by comparing with Pecs block type Ⅱ in the patients undergoing modified radical mastectomy. Methods Sixty-eight patients, aged 18-64 yr, with American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective modified radical mastectomy under general anesthesia, were divided into 2 groups (n=34 each) using a random number table method: Pecs block type Ⅱ plus anterior cutaneous branch of intercostal nerve block group (P+ A group) and Pecs block type Ⅱ group (P group). Anesthesia was induced with fentanyl, propofol and cisatracurium besilate, the patients were then tracheally intubated, and anesthesia was maintained with sevoflurane combined with nitrous oxide in both groups.In both groups, 0.25% levobupivacaine 10 ml was injected into the space between pectoralis major and pectoralis minor under ultrasound guidance, and then 0.25% levobupivacaine 10 ml was injected into the surface of the serratus anterior muscle at the level of 3rd rib for Pecs block type Ⅱ before operation.In group P+ A, 0.25% ropivacaine 10 ml (20 ml in total ) was injected into the interspace between the transverse thoracic and intercostal muscles in the junction area at the level of 4th and 5th ribs to perform anterior cutaneous branch of the intercostal nerve block.The equal volume of normal saline was given instead in group P. Morphine was given for analgesia when visual analogue scale score>3 or when the patients required.The cumulative amount of morphine administered at 24 h after surgery was recorded.The development of postoperative nausea and vomiting was observed. Results Compared with group P, the cumulative amount of morphine administered at 24 h after surgery was significantly decreased, and the postoperative analgesia time was prolonged in group P+ A (P 0.05). Conclusion Combination of anterior cutaneous branch of the intercostal nerve block and Pecs block type Ⅱ provides better analgesic efficacy for early postoperative analgesia than Pecs block type Ⅱ alone in the patients undergoing modified radical mastectomy. Key words: Nerve block; Pain, postoperative; Modified radical mastectomy