الفهرس 
Introduction
Chapter 1: Neural innervation of the breastOnly 14 pages are availabe for public view
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Abstract
This study aimed at evaluating the analgesic efficacy of Pecs II and TTP blocks in modified radical mastectomy patients, looking forward to adequate, and safe adequate intraoperative and postoperative analgesia that was never reached by other modalities.Patients with the following criteria were included in the study (age between 35 and 70 years old, physical status I or II, submitted for elective modified radical mastectomy cases with or without axillary lymph node dissection). Patients with the following criteria were excluded from the study (refusal, overweight, reconstructive breast surgeries, tumor infiltration or inflammation at site of injection, allergy to local anesthetics).In this study 90 patients who fulfilled the inclusion criteria were collected and allocated int two groups, each one included 45 patients, the study group who received Pecs II and TTP together with GA, the control group who received GA only.The study group received general anesthesia, then 45 ml of ropivacaine (0,25%) was injected with ultrasound guidance, where 20ml was injected between Pmm and serratus anterior muscle, 10 ml was injected between PMm and Pmm, and eventually 15 ml was injected between internal intercostal muscle and transversus thoracis muscle.The results showed statistically significant reduction in intraoperative fentanyl consumption, and so in the estimated fentanyl concentration in the blood at the end of surgery in Pecs group, but there was no statistical difference between the two studied groups regarding pain scores in the postoperative period, so the techniques adopted in this study can afford adequate intraoperative analgesia, but this limited intraoperative analgesia can be explained by low ropivacaine concentration, and the block duration can be elongated by additives as ketamine, and also by a catheter insertion in the interfacial planes for continuous drug infusion.