Objective: To explore the effect of different concentrations of methylene blue combined with ropivacaine for erector spinae plane block (ESPB) on postoperative analgesia and quality of early recovery in patients undergoing modified radical mastectomy.
Methods: Seventy-eight female patients undergoing modified radical mastectomy from June 2022 to November 2023, aged 20-64 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ, were divided into three groups by random number table method: 0.025% methylene blue combined with 0.25% ropivacaine 30 ml group (group M1), 0.05% methylene blue group combined with 0.25% ropivacaine 30 ml group (group M2), and 0.25% ropivacaine 30 ml group (group R), 26 patients in each group. ESPB was performed 30 minutes before anesthesia induction. VAS pain scores at rest and during activity (upper limb abduction) 30 minutes after extubation, 24 hours, 48 hours, 1 week, 1 month and 3 months after operation were recorded. The operation time, the intraoperative amount of bleeding, the PACU stay time and the number of rescue analgesia within 48 hours after operation were recorded. The quality of recovery-15 scale (QoR-15) scale was used to assess the quality of early rehabilitation 1 day before surgery, 1 day and 2 days after surgery. On the day of hospital discharge, a 5-point Likert scale was used to assess patient's satisfaction. Adverse reactions, including nausea, vomiting, block area pain, puncture site infection, hematoma, and local anesthetic intoxation within 48 hours after surgery were also recorded.
Results: Compared with group R, VAS pain scores at rest and during activity in groups M1 and M2 were significantly decreased 24 hours, 48 hours, 1 week, 1 month and 3 months after operation, the intraoperative remifentanil consumption was significantly decreased, the rate of analgesia relief was significantly reduced within 48 hours after surgery, the QoR-15 scores 1 day and 2 days after surgery were significantly increased (P < 0.05), the PACU stay time in group M1 was significantly shortened, the patient satisfaction was significantly increased, and the incidence of postoperative nausea was significantly decreased (P < 0.05). Compared with group M2, the PACU stay time in group M1 was significantly shortened, the QoR-15 scores and patient's satisfaction 1 day and 2 days after surgery were significantly increased, and the incidence of postoperative nausea was significantly decreased (P < 0.05). There were no statistical differences among the three groups in incidence of postoperative vomiting and block area pain. No puncture site infection, hematoma, and local anesthetic intoxation occurred in the three groups.
Conclusion: 0.025% and 0.05% methylene blue combined with 0.25% ropivacaine for ESPB can reduce postoperative pain, prolong analgesia time in patients undergoing modified radical mastectomy, and promote quality of early recovery. The use of 0.025% methylene blue combined with 0.25% ropivacaine in ESPB has higher comfort and safety. |
