Effect of pectoral nerve block II combined with general anesthesia on cellular immune function in patients undergoing radical mastectomy

Abstract

Objective To evaluate the effect of pectoral nerve (Pecs) blockⅡ combined with general anesthesia on cellular immune function in the patients undergoing radical mastectomy. Methods Eighty-two patients, aged 31-63 yr, with body mass index of 18-24 kg/m2, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective radical mastectomy, were divided into 2 groups (n=41 each) using a random number table method: general anesthesia group (group G) and Pecs blockⅡ combined with general anesthesia group (group P). In group P, Pecs block Ⅱ was performed under ultrasound guidance at 30 min before anesthesia induction, 0.33% ropivacaine 15 ml was injected into the fascia plane between the third intercostal pectoralis major and pectoralis minor, and then 0.33% ropivacaine 30 ml was injected into the anterior serratus muscle between the pectoralis minor and its deep side.Anesthesia was induced with iv propofol, sufentanil and rocuronium and maintained with iv infusion of propofol and intermittent iv boluses of sufentanil.Postoperative PCIA was performed with sufentanil and tropisetron.When visual analoge scale score>3, morphine 5-10 mg was intravenously injected.The intraoperative consumption of sufentanil and postoperative requirement for morphine used as rescue analgesics were recorded.Peripheral venous blood samples were collected before induction and at 3 and 24 h after operation for determination of the levels of T lymphocyte subsets (CD3+ , CD4+ and CD4+ /CD8+ ) by flow cytometry.Patients were followed up for 5 yr to record the survival and recurrence rates. Results The intraoperative consumption of sufentanil and postoperative requirement for morphine used as rescue analgesics were significantly lower in group P than in group G (P 0.05). Conclusion Pecs blockⅡ combined with general anesthesia can improve cellular immune function in the patients undergoing radical mastectomy. Key words: Nerve block; Thoraci cvertebrae; Anesthesia, general; Breastneo plasms; Immune function