الفهرس 
INTRODUCTION AND RATIONALOnly 14 pages are availabe for public view
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Abstract
One of the goals of the anesthesiologist is rendering patients insensible to pain during surgery. Peripheral nerve blocks are used for regional anesthesia, postoperative analgesia and treatment of chronic pain syndromes. Modified Pectoral nerve block or pectoral nerve block type II, is a novel approach aims to block at least the pectoral nerves, the intercostobrachial, intercostals II III-IV-V-VI and the long thoracic nerve.
These nerves need to be blocked to provide complete analgesia during modified radical mastectomy, and it is an alternative or a rescue block if paravertebral blocks and thoracic epidurals failed.
Ultrasound guidance has the advantage of real time identification of the neural anatomy, and directly determines the spread of local anesthetic within the interfacial plane. During ultrasound guidance, the structures through which the needle is inserted are defined, and the interfacial plane is directly localized and this will decrease the risk of complications and side effects.
In this prospective, randomized, comparative, we study the comparison between ultrasound guided modified pectoral nerve block before the surgical procedure and the same block after the end of surgery in anesthetized female patient undergoing modified radical mastectomy to evaluate the preemptive effect of that nerve block .
This study took place at Suez Canal University Hospital in the routine surgical theatres and surgical wards, where 42 American Society of Anesthesiologists’ physical statuses I, and II patients undergoing modified radical mastectomy were randomly allocated to two equal groups on alternative basis as following:
group Ι: (21 patients) received general anesthesia then ultrasound-guided pectoral nerve block type II before the surgical procedure.
group ΙΙ: (21 patients) received general anesthesia and pectoral nerve block type II just after the end of the surgical procedure and before recovery from general anesthesia.