Role of ketamine and tramadol as adjuncts to bupivacaine 0.5% in paravertebral block for breast surgery: A randomized double-blind study (original) (raw)
Related papers
BMC Anesthesiology, 2019
Background: Breast cancer surgery is one of the most common surgeries among the female population. Nearly half of the patients suffer chronic pain following breast cancer surgery, and 24% of them categorizing their pain as moderate to high. In this study, effects of ultrasound-guided erector spinae plane (ESP) block performed using two different concentrations of bupivacaine on postoperative tramadol consumption, pain scores, and intraoperative fentanyl requirements among patients who underwent radical mastectomy surgery were compared. Methods: This double-blinded, prospective, and randomized study included patients with age ranged 18-70, American Society of Anesthesiologist physical status I-II, and scheduled for unilateral modified radical mastectomy surgery. The patients were randomly allocated into two groups. In group I, ESP block was performed with 0.375% bupivacaine. In group II, ESP block was performed with 0.25% bupivacaine. General anesthesia was induced in both groups according to the standard procedures. When the pain score was ≥4, patients received intravenous (i.v.) 25 mcg fentanyl in the recovery room or 4 mg of morphine in the surgical ward as a rescue analgesia. The main measurements were postoperative tramadol consumption; Numerical Rating Scale (NRS) scores 15, 30, and 60 min and 12 and 24 h postoperatively; and intraoperative fentanyl requirements. Results: In total, 42 patients (21 patients in each group) were included in the study. The mean tramadol consumption at the postoperative 24th h was 149.52 ± 25.39 mg in group I, and 199.52 ± 32.78 mg in group II (p = 0.001). In group I, the NRS scores were significantly lower at every time points compared with those in group II. The mean intraoperative fentanyl requirement was similar in the two groups. Conclusion: Although ESP block performed with both concentrations of bupivacaine provided effective postoperative analgesia, the higher concentration of bupivacaine significantly reduced postoperative tramadol consumption after radical mastectomy surgery. Clinical trial registration: The study was registered prospectively with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12618001334291at 08/08/2018).
Pain physician
Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. A randomized, double-blind, prospective study. Academic medical center. This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 - 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block wi...
Journal of Anesthesiology and Clinical Science, 2019
Background: Postoperative pain plays a significant role in the pathogenesis of postoperative pulmonary complications after upper abdominal and thoracic opera¬tions. Diminishing lung volumes due to acute restrictive pulmonary dysfunction due to pain may result in relative hypoxemia, major atelectasis and pulmonary consolidation. Intrapleural analgesia is one of the method for postoperative analgesia. Methods and Material: After clearance from Institutional Ethics Committee, 80 patients undergoing modified radical mastectomy were selected and divided into two groups randomly. Group B: Intrapleural block was given with inj. Bupivacaine 0.5% (20 ml) with xylocaine adrenaline 10ml. Group BF: Block was given with Bupivacaine 0.5% (20 ml) with xylocaine adrenaline 10 ml with inj. Fentanyl 1 mcg/kg. Total duration of sensory block and analgesia, intraoperative hemodynamics, postoperative pain score and lung volumes and requirement of rescue analgesics were observed. Results: Hemodynamic parameters were comparable in both the groups. Onset of sensory block in group BF was faster (15.4±2.26) mins than group B (21.925±2.15) mins. Duration of sensory block was significantly higher in group BF (6.45±1.13) hrs than group B (3.5125±0.51) hrs. Total analgesia was significantly prolonged in group BF (11.3±1.0024 hrs) than group B (7.33±2.0153 hrs). Requirement of rescue analgesic dose in group BF was lower (2.05±0.67) than group B (3.025±0.69) Better preservation and earlier recovery of respiratory volumes noted in group BF. Conclusions: Intrapleural block given with local anaesthetic and fentanyl had faster onset and longer duration of sensory blockade with better preservation of lung volumes.
Preemptive Analgesia With Bupivacaine for Segmental Mastectomy
Regional Anesthesia and Pain Medicine, 2006
Background and Objectives: Preemptive analgesia is the concept of providing analgesia before surgical incision, resulting in less postoperative pain. The purpose of this study is to determine if preemptive and/or postoperative local anesthetic infiltration of bupivacaine in patients undergoing segmental mastectomy results in less postoperative pain compared with patients receiving placebo. Methods: In this prospective, double-blinded study, 120 patients were randomized into 4 groups: group 1, preincisional (10 mL) and postoperative (10 mL) wound infiltration of 0.5% bupivicaine, (ϩPreϩPost); group 2, preincisional bupivacaine (10 mL) and postoperative infiltration (10 mL) of placebo (normal saline solution), (ϩPreϪPost); group 3, preincisional placebo (10 mL) and postoperative bupivacaine (10 mL), (ϪPreϩPost); or group 4, preincisional (10 mL) and postoperative infiltration of placebo (10 mL), (ϪPreϪPost). All patients received a standardized laryngeal mask general anesthetic. Data were recorded at the following time intervals: preoperative admission, postanesthesia care unit (PACU) admission, PACU stay, stepdown-unit admission, stepdown-unit stay, hospital discharge, and 24 hours post operation. Results: No difference was noted with respect to preoperative pain visual analog scale (VAS, 0-100 mm), surgical duration, PACU stay time, stepdown-unit stay time, incidence of postoperative nausea, or treatment for nausea in all measured time periods. The placebo group (group 4) had significantly higher mean pain VAS scores during the early postoperative period (PACU admission and PACU stay) compared to the other groups (PACU admission: group 1 ϭ 2 Ϯ 8, group 2 ϭ 4 Ϯ 11, group 3 ϭ 3 Ϯ 15, group 4 ϭ 17 Ϯ 21, P Ͻ .01; PACU stay: group 1 ϭ 6 Ϯ 13, group 2 ϭ 6 Ϯ 10, group 3 ϭ 10 Ϯ 21, group 4 ϭ 20 Ϯ 18, P Ͻ .01). Likewise, the number of patients who reported pain (pain frequency) was significantly higher in group 4 (placebo) compared with all other groups at PACU admission, PACU stay, stepdown-unit admission, and stepdown-unit stay (P Յ .01). Conclusion: Preincisional and/or postoperative wound bupivacaine infiltration lacks preemptive analgesic effects for segmental mastectomy.
Thoracic paravertebral block for analgesia after modified radical mastectomy
Indian Journal of Pain, 2014
Background: Breast cancer is the most common type of cancer found in women and today represents a significant challenge to public health. Postoperative pain is the most distressing symptom experienced by the patient. Pain induces metabolic, hormonal and cardio-respiratory responses that affect the outcome of surgery. Aim of the Work: The aim of this study was to evaluate the role of ketamine as an adjuvant to bupivacaine in c-arm guided thoracic paravertebral block analgesia for modified radical mastectomy. Patients and Methods: This study was carried out in Tanta University Hospitals in Surgery Department from April 2016 to October 2016 on sixty-two patients scheduled for elective modified radical mastectomy divided into two equal groups each contain 31 patients, group 1 received PVB with bupivacaine only under c arm and group 2 received PVB with bupivacaine and ketamine as pre emptive analgesia and watch what is the outcome. Written informed consent was taken from each patient. Results: This prospective randomized double blind study was carried out on 62 patients divided into two equal groups where group two showed statistically significant decrease in VAS , total amount of analgesic and delay in time of first analgesic requirement in comparison with group one and significant difference as regard hemodynamics and postoperative complication between two groups. Conclusion: We concluded that addition of ketamine to bupivacaine as an adjuvant in C-arm guided PVB appears to be more beneficial than the use of bupivacaine alone for postoperative analgesia in modified radical mastectomy surgery.
https://www.ijrrjournal.com/IJRR\_Vol.5\_Issue.12\_Dec2018/Abstract\_IJRR0026.html, 2018
Background: The present study has been undertaken to evaluate pre-emptive analgesic and opioid sparing effect of intravenous ketamine in patients undergoing total radical mastectomy. Method: Eighty female patients undergoing breast cancer surgery under general anesthesia, in a double-blinded, placebo controlled study were randomly divided into two groups of 40 patients each. Group K received ketamine 0.3mg/kg IV just before induction. Group C received normal saline as placebo. Result: Time to first analgesic dose (TFA) required was significantly delayed in ketamine as compared to placebo group. Statistically significant difference was seen in Visual analog score (VAS), Prince Henry score (PHS) and mean morphine consumption between ketamine and control group. Conclusion: This study proved that ketamine has a definitive role in reducing postoperative pain and has opioid sparing effect in patients undergoing modified radical mastectomy.
Cureus
Background: In contrast to other breast surgeries, modified radical mastectomy (MRM) with axillary lymph node clearance involves intense tissue dissection, with postoperative seroma formation and pain being the major complaints affecting patients. Among these, 40% of females experience acute postoperative pain, and between 25 to 60% develop persistent chronic postsurgical pain. The rationale of this study was that minimally invasive procedures can result in immediate pain relief in patients undergoing mastectomy, which has been proven to satisfy their needs and lead to early discharge in the local population. Objective: This study determined to find out the efficacy of instilling bupivacaine on wounds by means of surgical drains in controlling pain after MRM. Methodology: This was a randomized control study trial that was carried out in Surgical Unit 1, Ward 3, Jinnah Postgraduate Medical Centre, Karachi, from November 2020 to April 2021. All patients tested negative for coronavirus disease 2019 (COVID-19) by PCR test before randomly allocating them into two groups. Thirty women in Group B received 40 ml of 0.25% injection bupivacaine, and 30 in Group C received no drug. Duration of analgesia was recorded as time in hours when the patient was received after surgery in the post-anesthesia care unit until the patient felt ache and discomfort of > three scores according to the visual analog pain score chart (VAS). Results: The average age was 52.48±4.76 years. The mean period of time during which analgesia was observed was significantly higher in Group B as compared to Group C (10.93±1.84 vs 5.03±1.35 hours, p=0.0005). Conclusion: There is improvement in postoperative analgesia after instilling bupivacaine through surgical drains on wound beds in MRM patients.
Indian Journal of Clinical Anaesthesia, 2021
Modified Radical Mastectomy is the widely followed treatment for operable breast cancers. Among the methods used to alleviate pain, irrigation of wound with 0.25% Bupivacaine is one of the under-utilized methods with good efficiency compared to other drugs.To evaluate the role of local irrigation of 0.25% bupivacaine in alleviating the post-operative pain. This observational study was conducted among 60 female patients who underwent Modified Radical Mastectomy in a tertiary care teaching hospital between January 2017 and July 2018. Thirty (30) patients were randomly allotted to control group, where the routine post-operative pain management was followed. Another 30 were randomly allotted to study group where, before closure of the wound, a 20G scalp vein set was used along the length of the incision with multiple punctures in it for continuous irrigation with 0.25% Bupivacaine. Post operatively Visual analogue scale was used to measure the pain sensation at every six hours for 24 ho...
Cureus
Background General anesthesia (GA) is a standard for breast malignant surgery. The issue of postoperative pain as well as the high occurrence of nausea and vomiting have prompted the quest for a superior methodology for tormenting the executives with fewer complications. Over the most recent couple of years, paravertebral block (PVB) has acquired huge fame either in combination with GA or alone for anesthetic management. In this study, we aim to evaluate the efficacy of morphine and clonidine as an adjunct to ropivacaine in PVB in breast cancer patients undergoing modified radical mastectomy. Methods In this study, a total of 90 patients were divided into the following three groups (30 each) based on a computer-generated random table. Group C (control): PVB with 0.25% ropivacaine (19 ml) 1 ml saline; Group M: PVB with 0.25% ropivacaine (19 ml) + 20 microgram/kg body weight morphine; Group N: PVB with 0.25% ropivacaine (19 ml) + 1.0 microgram/kg body weight clonidine. The postoperative pain intensity was recorded using the visual analog scale (VAS), and sedation was observed by the Ramsay Sedation Scale (RSS) score. Results The VAS was similar at zero hours, two hours, and four hours in the postoperative period among all the groups. There was a significant (p = 0.003) difference in VAS from six hours to 20 hours in the postoperative period among the groups. A significant (p < 0.05) difference was observed among the groups at eight hours to 20 hours. The first requirement of analgesia was significantly (p = 0.001) higher in Group N (7.70 ± 1.74) than in Group C (4.43 ± 1.43) and Group M (7.33 ± 2.21). Conclusion Morphine in the PVB provides better postoperative analgesia. The consumption of rescue analgesia was significantly reduced in the morphine group as compared to the clonidine group. The procedure also proved to be safe as no complication was encountered in the PVB in our study.
Objective: Postoperative analgesic effects of paravertebral block in mastectomy is still controversial. The purpose of the present study was to investigate the effectiveness of paravertebral block when given in addition to general anesthesia (GA), and whether a larger single dose or multilevel injections at successive levels are more useful for postoperative analgesia in mastectomy with lymph node dissection. Methodology: This randomized controlled non-blind study was undertken at operating rooms and the indoor facilities at our university hospital. Sixty female patients aged 40 to 65 years, ASA physical status I and II, for partial mastectomy with axillary lymph node dissection were included in the study after ethical committee approval. The patients were divided into three groups; control, single or multilevel block groups. Before GA, in the single block group, paravertebral block using 0.5% ropivacaine 15 ml was performed at T4 level, and in the multilevel group, paravertebral block was performed at T3, 4, and 5 levels with 0.5% ropivacaine 5 ml each. In the control group, no block was performed. GA was induced with midazolam, fentanyl, propofol, and vecuronium. Laryngeal mask airway #3 was inserted. Anesthesia was maintained with propofol infusion and intermittent fentanyl as necessary under 50% nitrous oxide in oxygen (total flow 4 L/min). For postoperative analgesia, pentazocine 15 mg was administered intramuscularly as patients' request. Measurements: The dose of fentanyl used during surgery, frequency of pentazocine request in postoperative 24 hours, time to the first pentazocine administration, and postoperative pain measured by visual analogue scale (VAS, 0 to10) for 24 hours were compared among the groups. Results: Dose of fentanyl during surgery was significantly larger in the control group than the single and multilevel groups. Frequency of postoperative pentazocine administration was significantly larger in the control group than the single and multilevel groups. There were no differences in the dose of fentanyl and frequency of pentazocine administration between the single and multilevel groups. Conclusion. Single large dose paravertebral block at T4 is equally useful for postoperative analgesia in mastectomy with lymph nodes dissection when compared to multilevel blocks at T3 to T5.