The Effect Of Ultrasound-guided Modified Pectoral Nerves Block Versus Ketamine Plus Magnesium Infusion On Analgesic Profile In Breast Cancer Surgeries
Keywords
Abstract
Description
Surgery on the chest wall is relatively common and can be associated with significant postoperative discomfort and pain; and one of the most common surgical sites on the chest wall is the breast, with the main indication for breast surgery being breast cancer. Breast cancer has continued to be the most common cancer in females, accounting for approximately 31% of all newly detected cancer cases in the female population, worldwide. (1, 2) Thousands of patients undergo surgery in the mammary and axillary regions every year, and these procedures tend to cause significant acute pain and may develop in to cases of chronic pain in 25-60% of cases. (3) Pain can be controlled using systemic opioids which have a respiratory depressant effect and causing nausea and vomiting.
Also can be controlled using epidural catheter that can cause haemodynamic instability, so we are searching about how to devrease pain with less complications.
Dates
| Last Verified: | 01/31/2020 |
| First Submitted: | 06/27/2019 |
| Estimated Enrollment Submitted: | 09/16/2019 |
| First Posted: | 09/18/2019 |
| Last Update Submitted: | 02/23/2020 |
| Last Update Posted: | 02/25/2020 |
| Actual Study Start Date: | 11/11/2017 |
| Estimated Primary Completion Date: | 08/10/2020 |
| Estimated Study Completion Date: | 09/14/2020 |
Condition or disease
Intervention/treatment
Procedure: pectoral nerves block group
Drug: Ktamine plus Magnesium group
Drug: Control Group
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| Active Comparator: pectoral nerves block group modified pectoral nerves block was performed on the side of surgery | Procedure: pectoral nerves block group ultrasound guided block of nerve supply of surgical site |
| Active Comparator: Ktamine plus Magnesium group Patients received 40 mg/kg of magnesium sulphate infusion in 100cc normal saline, as a bolus dose, in addition to 0.2mg/kg of ketamine as a bolus dose, 15 min before the induction of general anesthesia. This was followed by intraoperative continuous infusion of 10 mg/kg/h of magnesium sulphate combined with infusion of 0.1mg/kg/h ketamine that was started before skin incision and continued until completion of skin closure via infusion pump | Drug: Ktamine plus Magnesium group Patients received 40 mg/kg of magnesium sulphate infusion in 100cc normal saline, as a bolus dose, in addition to 0.2mg/kg of ketamine as a bolus dose, 15 min before the induction of general anesthesia. This was followed by intraoperative continuous infusion of 10 mg/kg/h of magnesium sulphate combined with infusion of 0.1mg/kg/h ketamine that was started before skin incision and continued until completion of skin closure via infusion pump (Atom Syringe Pump S-1235). |
| Active Comparator: Control Group Normal saline infusion with similar rate and volume to KM infusion was used as a placebo | Drug: Control Group Normal saline infusion with similar rate and volume to KM infusion was used as a placebo. |
Eligibility Criteria
| Ages Eligible for Study | 18 Years To 18 Years |
| Sexes Eligible for Study | Female |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: - female patients with American society of Anesthesia classification(ASA) II physical status undergoing major breast cancer surgery with axillary evacuation under general anesthesia. - Patients' age from18 to 65 Years. - Body mass index (BMI) are from 20 to 40 kg/m2. Exclusion Criteria: - Pregnant patients - Patients having sensitivity or contraindication to test drugs or regional anesthesia. - severe respiratory or cardiac disorders. - history of psychological disorder. - chronic pain . - significant liver or renal insufficiency. . |
Outcome
Primary Outcome Measures
1. total morphine requirements [24 hours postoperatively]
Secondary Outcome Measures
1. fentanyl consumption [intraoperative period]
2. Visual analogue scale score [immediately after recovery and then at 1, 4, 8, 12, and 24 hours postoperatively.]
3. Sedation score [A sedation level recorded upon arrival to the PACU and at 1, 4, 8, 12, and 24 hours postoperatively.]
4. Nausea and vomiting [during the first post-operative 24 hours]
