Efficacy of adding tramadol as adjunctive analgesic with levobupivacaine in modified pectoral nerve block for modified radical mastectomy surgery

摘要

Breast surgeries are usually associated with sever postoperative pain, sever acute postoperative pain after breast surgery is considered a risk factor for the development of chronic postmastectomy pain, good perioperative analgesic technique for breast surgery is always questionable [1]. Pectoral nerve block (PecS block) produces good analgesia and it is less invasive procedure compared to thoracic epidural and paravertebral blocks which may cause complications as total spinal anesthesia, inadvertent intravascular drug injection and peumothorax [2], PecS block has been used as analgesic technique firstly by Blanco in minor breast surgery, and achieved block of nerves that innervate the pectoralis muscles [3]. Later on Blanco and Colleague in Pecs II achieved a modification with involving the axilla aiming at blocking the pectoral, intercostals, intercostobrachial, and long thoracic nerves [4,5].