Different analgesic routes of magnesium sulfate: Intravenous versus pectoralis II interfascial plane block for breast cosmetic surgeries

Abstract

Purpose:The purpose of the study is to evaluate the most effective analgesic route of magnesium sulfate (MgSO4) either intravenous (i.v.) or pectoralis interfascial plane block.Patients and Methods:Fifty adult female patients were divided into two equal groups: i.v. MgSO4 and Pecs II block MgSO4 (Pecs MgSO4) group. After general anesthesia, in i.v. MgSO4 group, the local anesthetic (LA) for Pecs II block was prepared by adding 3 mL saline to 57 mL bupivacaine 0.25% divided equally for each side. A bolus i.v. solution of MgSO4 10% 0.5 mL.kg-1 diluted in saline in a total volume of 100 mL was given over 15 minutes. Then, the solution for continuous i.v. infusion; 30 mL MgSO4 10% and 70 mL saline was infused at the rate of 0.5 mL.kg-1.h-1 intraoperatively. For PecsMgSO4 group, LA formed of 3 mL MgSO4 10% added to 57 mL bupivacaine 0.25%. Whereas, 100 mL saline was given as bolus i.v. followed by continuous infusion of 100 mL normal saline at the rate of 0.5 mL.kg-1.h-1.Results:In the group received MgSO4-bupivacaine Pecs II block, there was a nonsignificant decrease in postoperative morphine consumption compared to i.v. administration of MgSO4. The two groups were comparable in the intensity of pain and sedation scores.Conclusion:The use of bupivacaine Pecs II block enhanced with addition of MgSO4 to pectoralis interfascial plane block or intravenously in patients underwent breast cosmetic surgeries under general anesthesia was associated with comparable results of the postoperative morphine requirements, intensity of postoperative pain, and extension of the duration of postoperative analgesia. The intraoperative hemodynamic effects i.v. MgSO4 were superior to the pectoralis interfascial plane route of administration.

The Efficacy of Pectoralis Nerve Blockade in Breast Reductions

“…Before the introduction of regional blocks, postoperative pain management after breast surgery was limited to intravenous and oral narcotics 2 . Regional nerve blocks, resulting in analgesia to the chest wall, have been found to be an excellent adjunct in postoperative pain control 3 …”

“…2 Regional nerve blocks, resulting in analgesia to the chest wall, have been found to be an excellent adjunct in postoperative pain control. 3 First described by Blanco et al 4 in 2012, the pectoral nerve (Pecs) II block offers a simple and safe method for chest wall analgesia. The Pecs II block is an interfascial block.…”