Paravertebral Block for Breast Surgeries (original) (raw)
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Journal of Evolution of medical and Dental Sciences, 2013
BACKGROUND: this randomised control trial is to evaluate unilateral para- vertebral block in elective breast surgery in comparison with general anaesthesia METHODS: 106 patients of breast surgery were randomised in 2 groups- group-P and group-G. group-P patients received unilateral multiple level paravertebral block with 0.25% levo-bupivacaine at T2 to T5 level and group-G patients received general anaesthesia. Pulse, BP were recorded in the perioperative period and rescue analgesic requirement time and VAS scores were recorded in PACU. Recorded data were evaluated after that. RESULTS: In PACU rescue analgesia needed in group-P in 69.22 minutes and in group-G in 41.27 minutes. Post-operative VAS scores were lower in group-P patients at 30 minutes, 1 hr. and 2 hr. There was no incidence of hypotension or hypertension or bradycardia or tachycardia in any group. Patients overall satisfaction score in group-P was 4 vs 3.6 in group-G (p value <0.05) CONCLUSION: Thoracic para-vertebral...
Indian journal of applied research, 2015
Objective: To study efficacy of Thoracic Paravertebral Block (TPVB) with 0.125% Bupivacaine by Catheter Technique for Postoperative Analgesia in Breast Surgery. Methods: This randomized controlled trial was conducted in females admitted in surgery wards for breast surgery of any type in the age group of 18-60 years, in tertiary care hospital in Western Maharashtra in India. Period of study was from January 2008 to December 2009. After obtaining informed consent and informing Visual analogue scale (VAS), cases were enrolled in two groups A and B. Sample size was 30 in each group. Group A received Thoracic paravertebral block by catheter technique with 0.125% Bupivacaine 15 ml single infusion and group B received intra muscular Diclofenac Sodium 75 mg single dose towards end of surgery. Results: In group A at the end of 1st hour mean Visual Analogue Scale (VAS) was 0 and in group B it was 0.233 with Standard Deviation (SD) of 0.678 with p value of 0.04 which is statistically significant. At the end of 5th hour mean VAS in group A was0.266 and in group B it was 1.13 with SD of 1.43 and p value of 0.007 which is statistically significant. Conclusions: Thoracic Paravertebral Block (TPVB) with 0.125% Bupivacaine by catheter technique is more efficacious than intramuscular Diclofenac Sodium for postoperative analgesia in breast surgery.
Improved Postoperative Pain Control using Thoracic Paravertebral Block for Breast Operations
The Breast Journal, 2009
n Abstract: Thoracic paravertebral block (PVB) in breast surgery can provide regional anesthesia during and after surgery with the potential advantage of decreasing postoperative pain. We report our institutional experience with PVB over the initial 8 months of use. All patients undergoing breast operations at the ambulatory care building from September 09, 2005 to June 28, 2005 were reviewed. Comparison was performed between patients receiving PVB and those who did not. Pain scores were assessed immediately, 4 hours, 8 hours and the morning after surgery. 178 patients received PVB and 135 patients did not. Patients were subdivided into three groups: Group A-segmental mastectomy only (n = 89), Group Bsegmental mastectomy and sentinel node surgery (n = 111) and Group C-more extensive breast surgery (n = 113). Immediately after surgery there was a statistically significant difference in the number of patients reporting pain between PVB patients and those without PVB. At all time points up until the morning after surgery PVB patients were significantly less likely to report pain than controls. Patients in Group C who received PVB were significantly less likely to require overnight stay. The average immediate pain scores were significantly lower in PVB patients than controls in both Group B and Group C and approached significance in Group A. PVB in breast surgical patients provided improved postoperative pain control. Pain relief was improved immediately postoperatively and this effect continued to the next day after surgery. PVB significantly decreased the proportion of patients that required overnight hospitalization after major breast operations and therefore may decrease cost associated with breast surgery. n
Open Journal of Anesthesiology, 2019
Background and Aims: Erector spinae plane block, Paravertebral block and serratus anterior block are three formats for analgesia post-operatively following radical mastectomy. This study compares the analgesic efficacy of these modalities for analgesia post-operatively by articaine 2% with adrenaline. Methods: Seventy-five patients with ASA physical status I or II subjected to modified radical mastectomy with axillary clearance were enrolled for the study. After induction of general anaesthesia all patients received 20 mL 2% articaine with adrenaline in each technique of the study. Patients in Group 1 (Erector spinae block [ESB], n = 25), Group 2 paravertebral block [PVB] n = 25), Group 3 (serratus anterior plane block [SAPB] n = 25) were ultrasound-guided on ipsilateral side. Patients were estimated for pain scores at 0, 2, 4, 6, 12 and 24 h, and duration of analgesia post-operatively and relieve analgesic doses required of morphine up to 24 h. Results: Visual analogue scale scores post-operatively were lower in ESB and PVB group compared with SAPB at 4, 6, 12 and 24 h (P < 0.05). The first analgesic dose requirement was significantly longer in ESB (416 ± 68 min) than PVB group (371 ± 67 min) in compared with SAPB (343.5 ± 54.7 min). Mean duration of analgesia was significantly longer in ESB and PVB group (P < 0.001) in compared with SAPB. Total morphine dose of relieving analgesic was significantly lesser in ESB (4 ± 2 mg) than PVB group (6 ± 2 mg) compared with SAPB
Sri Lankan Journal of Anaesthesiology, 2022
Objectives: This study is aimed at testing the efficacy of ultra sound guided erector spinae plane block (ESPB) with 20ml of 0.2% ropivacainein providing postoperative analgesia in patients undergoing breast surgery. Materials and Methods: After seeking approval from the hospital ethics committee and obtaining written informed consent from participants, this single blinded prospective randomised control study was conducted on 60 patients posted for breast surgery under general anaesthesia. The recruited participants were randomly assigned into two equal groups B and C by closed envelope technique.Group B patients were given ultrasound-guided ESPB with 20 ml of 0.2% ropivacaine and Group C patients were given routine postoperative port site infiltration with 20 ml of 0.2% ropivacaine. Postoperative pain and need for rescue analgesics were noted. Chi-square test, independent sample t test, Mann Whitney U test was used for statistical analysis. Results: Pain score was lower in Group B patients up to 12h (P<0.007). At 24h the pain scores between the two groups were comparable. The rescue analgesic requirement was also significantly less in group B compared to Group C (23.3% vs. 70%), and this difference was statistically significant (P=0.01). On comparing the incidence of postoperative nausea and vomiting, there was no significant difference between the two groups. No adverse events were noted in both groups. Conclusion: Ultrasound-guided ESPB with 20ml of 0.2% ropivacaine is superior to local infiltration in providing postoperative analgesia in patients undergoing breast surgery. It also decreases postoperative tramadol requirement.
IOSR Journals , 2019
Postoperative pain is both distressing and detrimental for the patient. Both PEC (I & II) and ESP blocks seem potentially safer and effective nerve blocks for postoperative analgesia. This study was done to compare the intraoperative hemodynamic parameters, postoperative pain scores (VAS), total analgesic consumption and time of first rescue analgesic dose between the groups. PECS provides more beneficial outcomes in patients with breast surgeries in contrast to ESP. Material and methods-Thirty-four female patients(ASA I, II), aged between 18 and 60 years, scheduled for breast surgery were studied in this randomized double-blinding protocol, conducted in a tertiary care hospital in Lucknow over a period of one year. Patients were randomly divided into one of the two groups PEC-I & II (Group A) and Erector Spinae (Group B) with the usage of 0.2% Ropivacaine. Intraoperative hemodynamic and postoperative VAS score, time of first rescue analgesia, total opioid consumption and patient satisfaction score were analyzed. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 21.0 Statistical Analysis Software. Results Among hemodynamic parameters "preoperatively" and "before shifting from OT" suggest that RR and SBP were statistically different in "preoperatively" and "before shifting from OT" measurements in the ESP group patients as compared with PECS group patients. The mean VAS score values in PECS and ESP group patients at 4 hours was 0.125 ± 0.48 and 0.706 ± 0.98 respectively. The total analgesic consumption in the patients of PECS was lesser than in the ESP group (p-value<0.0001). The total time required for first rescue dose was significantly lesser in ESP group patients in contrast to PEC group. Patients' satisfaction rate was higher in PEC group patients (82.5%) in contrast to ESP group patients (23%) (p < 0.05). Conclusion USG guided PECS block (I & II) is better as compared to Erector spinae plane block in view of postoperative analgesia, opioid related complications and overall patients' satisfaction in breast surgeries using 0.2% Ropivacaine.
SpringerPlus, 2014
We hypothesized that improved acute postoperative pain relief will be achieved using general anaesthesia (GA) either in combination with continuous thoracic paravertebral block (GA-cPVB) or single shot (GA-sPVB) as compared to GA supplemented by local wound infiltration (GA-LWI) after unilateral major breast cancer surgery. A randomised controlled trial was conducted in 46 adult women in a day-care or short-stay hospital setting after major breast cancer surgery. Pain-intensity was measured using an 11-point visual analogue scale (VAS) until postoperative day 2. GA-sPVB was stopped due to slow inclusion. No significant difference in VAS score was noted between GA-LWI (VAS median 0.5 (interquartile range 0.18-2.00)) and GA-cPVB, (VAS 0.3 (0.00-1.55, p = 0.195)) 24 hours after surgery or at any point postoperatively until postoperative day 2. We conclude that both GA-LWI and GA-cPVB anaesthetic techniques are equally effective in treatment of acute postoperative pain after major oncological breast surgery. As GA-LWI is easily to perform with fewer complications and it is more cost-effective it should be preferred over GA-cPVB.
Egyptian Journal of Anaesthesia, 2011
Background: Use of adjuncts to local anesthetics is believed to enhance the quality and duration of the peripheral nerve blocks. We tested the hypothesis that addition of ketamine or tramadol to bupivacaine 0.5% in PVB for patients undergoing modified radical mastectomy would enhance postoperative analgesia. Methods: We prospectively randomized 60 ASA I-III women into three groups: group B (n = 20) who received PVB using plain bupivacaine 0.5% (control group), group K (n = 21) who received ketamine (0.5 mg kg À1 ) added to bupivacaine 0.5%, and group T (n = 19) who received tramadol (1.5 mg kg À1 ) added to bupivacaine 0.5%. All the patients were then given a standardized general anesthesia. Primary outcome was the cumulative fentanyl dose given through patient-controlled analgesia (PCA) device in the first 24 h after surgery. Secondary outcomes included dose of fentanyl in the postanesthesia care unit (PACU), time to first dose of fentanyl, and visual analogue scale (VAS) pain scores in PACU and ward.