Efficacy of Peripheral Nerve Stimulator Guided Pectoral Nerve Block-1 and Serratus Anterior Plane Block for Post-operative Analgesia in Modified Radical Mastectomy: A Randomized Controlled Study

BACKGROUND

Breast carcinoma is one of the most common cancers in present-day women worldwide, hence surgical intervention for the same is inevitable. General anesthesia being the preferred technique, the selection of appropriate postoperative pain management is a major concern in which superficial fascial plane chest wall blocks play a pivotal role. We aimed to prove the efficacy of peripheral nerve stimulator-guided pectoral nerve-1 (PEC 1) block and serratus anterior plane (SAP) block for postoperative analgesia in modified radical mastectomy.

METHODS

This prospective randomized controlled clinical study comprised 60 females undergoing modified radical mastectomy and was randomly allocated to two groups. Group A patients received general anesthesia while, in addition to general anesthesia, group B patients received PEC 1 and SAP blocks. Postoperatively the active and passive visual analog score (VAS), duration of analgesia, cumulative requirement of rescue analgesics in the first 24 hours and associated perioperative complications were noted. All quantitative data were analyzed by student t-test and qualitative data by chi-square test using MedCalc software 12.5.

RESULTS

VAS score for first 24 hours in group B was lower at rest, on pressure over the surgical site as well as on movements compared with the patients in group A with the p-value being < 0.0001 at all time intervals. Time for receiving first rescue analgesia was shorter (1.25±0.56hour vs 20.05±7.78hour, p<0.001) with the significantly higher requirement of cumulative doses of tramadol in the first 24 hours in patients belonging to group A (233.33±47.95mg vs 110±31.62 mg, p<0.001).

CONCLUSION

PEC 1 and SAP blocks given under peripheral nerve stimulator guidance have a high success rate and are reliable in providing adequate postoperative analgesia for patients undergoing modified radical mastectomy.

Tracheal intubation with King Vision video laryngoscope in patients with cervical spine instability-Comparison of straight versus curved reinforced endotracheal tubes

Background and Aims:

King Vision video laryngoscope is commonly used to facilitate intubation in corrective surgery for cervical spine instability patients due to less manipulation. Curved and straight reinforced tracheal tubes are regularly used in this surgery as neck of the patient is likely to be flexed. We aimed to compare intubation characteristics between the curved and straight reinforced tubes through King Vision video laryngoscope in patients to be operated for cervical spine instability with the primary objective being intubation time.

Methods:

Sixty patients undergoing cervical spine surgery were enroled in this prospective randomised comparative clinical study. All were intubated after applying manual in-line stabilisation of the neck, using either curved (group C) or straight (group S) reinforced endotracheal tubes through King Vision video laryngoscope. The intubation time, number of attempts, incidence of tube impingement with arytenoids/aryepiglottic folds, optimisation manoeuvres required and complications were observed. Unpaired ‘t’ test and Chi-square test were used to analyse the data using MedCalc software, version 12.5.

Results:

Time taken for intubation was shorter with curved compared to straight reinforced tube (16.24 ± 3.09 vs. 29.08 ± 5.48 seconds, P < 0.0001) The first attempt success rate was higher using curved than straight reinforced tube (93.3% vs. 70%, P = 0.02). Incidences of impingement with arytenoids/ aryepiglottic folds and optimisation manoeuvres required more with the straight reinforced tube.

Conclusion:

The intubation was fast and with higher first attempt success rate with curved than with straight reinforced tube through King Vision videolaryngoscope when used in patients with cervical spine instability.