الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common cancer in women, it is about (38.8%) of all types of cancer affecting female in egypt. Postoperative pain is one of the greatest patient concerns following any surgery. Although an increased emphasis has been placed on pain management, approximately 80% of surgical patients repot postoperative Pain with 86% of patients rating their pain as moderate, severe, or extreme.
Patients undergoing breast surgery require a multimodal postoperative pain treatment regimen that provides high quality analgesia with minimal side effects. Until now, oncologic breast surgeries are typically performed by general anesthesia. However, general anesthesia cannot provide adeguate postoperative pain control and routine use of parenteral opoids aggrevate postoperative sedation, nausea, emesis, impaired oxygenation and decrease ventilation. Many studies have benn carried out trying to find a solution for these dilemma thus different analgesic modalities as local infilteration of surgical field, systemic analgesia, neuro-axial blocks, and nerve blocks.
Paravertebral block became the gold standard to achieve postoperative pain relief afer breast surgery, but not every anesthiologist is comfortable performing these procedures. As an alternative for these technigues pectoral nerve block was designed.
Pectoral nerve block are perioheral nerve block alternative to paravertebral block for providing postoperative analgesia for breast surgery. The Pecs block is arecently described, easy and reliable superficial block that targets the lateral and median nerves at an interfascial plane between the pectoralis major and minor muscles. It can be used for different breast operations, other potential indications are traumatic chest injuries, iatrogenic pectoral muscle dissections, pacemakers, portacaths and chest drains.
The modified Pecs block produces excellent analgesia and can be used to provide a balanced anesthesia and as a rescue block in cases where analgesia provided by the paravertebral or epidural was patchy or ineffective.
The peimary aim of this work was to to compare the efficacy of the ultrasound guided paravertebral block and pectoral nerve block in decreasing the intensity of postoperative pain using visual analogue scale and the duration of analgesia. The secondary aims are to compare hemodynamics effect, safety and side effects of the two blocks.
The present study was carried out in Alexandria Main University hospitals on 36 female patients age 25-50 years old, American Society Of Anesthesiologists (ASA) class I or II scheduled for elective unilateral modified radical mastectomy.
Exclusion criteria
History of allergy or contraindication to any of the studied drugs.
Patient refusal.
Skin infection at the site of in