关键词: 肋间神经阻滞, 联合麻醉, 术后镇痛, 恶心、呕吐

Abstract: Background and purpose: Many patients may suffer from acute pain after radical mastectomy under general anesthesia. This article aimed to investigate the effect of intercostal nerve block coupled with general anesthesia on analgesia after radical mastectomy for breast cancer. Methods: Ninety-six patients underwent modified radical mastectomy for breast cancer were randomized with random number into group C (intercostal nerve block coupled with general anesthesia) and group G (general anesthesia), with 48 patients in each group. Group C received intercostal nerve block by ultrasound before general anesthesia. Group G received only general anesthesia. The induction of general anesthesia was the same between the two groups. During the surgery, 10 μg sufentanil was given to the patient if heart rate or blood pressure were 20% higher than baseline. After surgery, sufentanil was given if VAS score exceeded 0 point. The perioperative amount of sufentanil was recorded. VAS scores were recorded respectively on 2 (T1), 12 (T2) and 24 h (T3) after surgery. The incidence of postoperative nausea and vomiting was also observed. Results: Sufentanil amount used intra- and post- operation were significantly lower in group C [(25.2±3.5) and (3.3±1.2) μg] than that in group G [(40.5±4.3) and (8.4±2.2) μg] (P＜0.01). The VAS scores on 2, 12 and 24 h after surgery in group C 0.45±0.15, 1.75±0.08 and 2.05±0.12), were significantly lower than those in group G (4.32±0.21, 4.88±0.13 and 4.78±0.16) (P<0.01). The incidences of nausea and vomiting on 2 and 24 h after surgery in group C (6.25% and 16.66%) were significantly lower than those in group G (20.8% and 41.66%). There was no adverse complication related with intercostal nerve block in group C. Conclusion: Intercostal nerve block coupled with general anesthesia plays an important role in preemptive analgesia for patients undergoing modified radical mastectomy for breast cancer, which may improve postoperative pain control and reduce the usage of opioids and incidence of nausea and vomiting. Intercostal nerve block under ultrasound is quite safe and effective for patients.

Key words: Intercostal nerve block, Combined anesthesia, Postoperative analgesia, Nausea and vomiting