A Randomized Double Blind Study Comparing Post-Operative Analgesia Provided by Multilevel Thoracic Paravertebral Block Using Bupivacaine (0.5%) and Ropivacaine (0.5%) in Breast Surgery (original) (raw)
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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.
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...
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
Introduction : Breast cancer is one of the most common cancers in women,requiring frequent surgical intervention. Adequate painrelief with parenteral and regional anaesthesia techniques improves respiratory outcome and decreases postoperative complications. Aim: To compare the postoperative analgesic efficacy and safety profile of thoracic epidural and thoracic paravertebral block using continuous infusion of bupivacaine in patients undergoing elective modified radical mastectomy. Materials and methods: A prospective randomized double-blinded study was conducted in 60 patients undergoing modified radical mastectomy under general anesthesia.30 patients in Group P received paravertebral block at T6-T7 level and 4 cm of catheter was directed cephalad,30 patients in group E received epidural block at T6-T7 level and 4 cm of catheter was directed cephalad .After extubation, the 0.125% bupivacaine infusion started, postoperative pain VAS score, haemodynamics and need for rescue analgesics observed and recorded Results:The statistical analysis showed that better hemodynamic stability was maintained in group P. However, in both the group P and group E postoperative analgesic efficacy was equally comparable. Conclusion:This study concludes that both thoracic epidural and thoracic paravertebral block provide comparable post operative analgesia in patients undergoing elective major breast surgery.
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.
Comparision of thoracic epidural block vs paravertebral block in patients under going breast surgery
Indian Journal of Clinical Anaesthesia, 2015
Objective: Despite advances in medical treatment, surgical intervention is often associated with postoperative pain, nausea, and vomiting. While epidural analgesia is considered the gold standard for postthoracic surgery pain relief even Paravertebral nerve block (PVB) has the potential to offer equal postoperative pain relief and fewer side effects when used for breast surgery. Method: We compared thoracic PVB with epidural block in a double-blinded, prospective, randomized study of 60 women scheduled for unilateral breast surgery. Patients were divided into two groups of 30 each, Group E (Thoracic epidural group), Group P (Thoracic paravertebral group), each who received 15ml of 0.5% Ropivacaine either in the thoracic epidural region or thoracic paravertebral region. Results: Patients receiving epidural showed a fall in mean arterial pressure leading to significant p-value at 10, 20, 30, 40, 50 min, 1hr, 1 hr PO. The fall was soon addressed with fluid bolus and if not responding v...
East and Central African Journal of Surgery, 2016
Background: In this pilot study, we evaluated the postoperative analgesic effect of the new lamina thoracic paravertebral block using a single-shot technique for major breast cancer surgery. Methods: A retrospective observational design was used to compare data involving 16 consecutive ASA 1 and 2 female patients who had unilateral modified radical mastectomy with axillary clearance under general anaesthesia with paravertebral block and 15 others without block between 13/03/2014 to 12/05/2015. We compared the time to the first request for analgesic, total analgesic (opioid and non-opioid) consumption (in mg) and postoperative pain scores over 72 h between the two groups. Results: One patient was excluded from the cohort due to block failure. The median time to first request for analgesic was 43 h (25.2-73.0 h) in the block group versus 2 h (1.0-2.5 h), p=0001. The pain scores was significantly lower at all measurement points among the block patients compared with the no-block group until 24 h postoperatively. No patient in the block group required analgesic within 24 h after surgery. The total consumption of pentazocine was nil (block group) vs. 154.0±74.2 (range 90-300) mg, p=0.0000001. Conclusions: Single-shot lamina paravertebral block provided prolonged postoperative analgesia and reduced opioid and non-opioid consumption.
Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery
Egyptian Journal of Anaesthesia, 2014
Background: Pectoral nerve block (Pecs) is a novel interfascial plane block which can provide analgesia after breast surgery while paravertebral block (PVB) is widely used for this purpose. We evaluated the difference between the two techniques in regard to morphine consumption and analgesic efficacy after modified radical mastectomy (MRM). Methods: Sixty patients undergoing elective MRM were randomly allocated into either PVB with 15-20 ml of levobupivacaine 0.25% at the level of fourth thoracic vertebra or Pecs block with 10 ml of levobupivacaine 0.25% injected inbetween pectoralis major and pectoralis minor muscle and another 20 ml levobubivacaine 0.25% inbetween pectorlis minor and serratus anterior muscle. Primary outcome measure was morphine consumption in the first 24 h while secondary outcome measures included pain scores, intraoperative fentanyl consumption as well as postoperative nausea and vomiting (PONV). Results: Postoperative morphine consumed at 24 h was significantly lower in Pecs group [21 (20-25) mg] than in PVB group [28 (22-31) mg], (p = 0.002). Time for first request of morphine was longer in Pecs group [175 (155-220) min] than in PVB group [137.5 (115-165) min], (p < 0.001). Numerical rating score (NRS) at rest was lower in Pecs group compared with PVB group at 1 h, 6 h and 12 h (p < 0.001) but at 18 h and 24 h it was lower in PVB group compared with Pecs group (p = 0.008 and <0.001 respectively). During movement, NRS was significantly lower at 1st hour in Pecs group (p < 0.001) while at 18 h and 24 h it was significantly lower in PVB group (p < 0.001). PONV was comparable between both groups. Conclusion: Pecs block reduced postoperative morphine consumption in the first 24 and pain scores in the first 12 h in comparison with PVB after mastectomy.
Annals of Surgical Oncology, 2014
Background. The objective of this study was to compare the effect of thoracic paravertebral block (TPVB) and local anesthetic (LA) on persistent postoperative pain (PPP) 1 year following breast cancer surgery. Secondary objectives were to compare the effect on arm morbidity and quality of life. Methods. Women scheduled for elective breast cancer surgery were randomly assigned to either TPVB or LA followed by general anesthesia. An NRS value of[3 at rest or with movement 1 year following surgery defined PPP. Blinded interim analysis suggested rates of PPP much lower than anticipated, making detection of the specified 20 % absolute reduction in the primary outcome impossible. Recruitment was stopped, and all enrolled patients were followed to 1 year. Results. A total of 145 participants were recruited; 65 were randomized to TPVB and 64 to LA. Groups were similar with respect to demographic and treatment characteristics. Only 9 patients (8 %; 95 % CI 4-14 %) met criteria for PPP 1 year following surgery; 5 were in the TPVB and 4 in the LA group. Brief Pain Inventory severity and interference scores were low in both groups. Arm morbidity and quality of life were similar in both groups.
Paravertebral Block for Breast Surgeries
Introduction: 40% of patients undergoing breast surgery have shown to have inadequate pain relief. Para vertebral block (PVB) has been successfully used to provide long lasting unilateral anesthesia for multiple thoracic and abdominal procedures. Thoracic par vertebral block (TPVB) is providing beneficial in breast surgeries, especially those with malignancies. Study aimed to see the effect of para vertebral block using dexmeditomidine (1mcg/kg) with 0.2% ropivacaine as an adjuvant to general anesthesia in patients undergoing breast surgery. Material and methods: After obtaining ethical clearance and patient consent, 60 patients of ASA physical status I and II, aged 20-65, scheduled for unilateral breast surgery were enrolled in this randomized, double blinded, prospective clinical study. Patients were randomized in groups RD (n=30) and RS (n=30) to receive either (22ml of 0.2%) with 2ml of 1mcg/kg) or ropivacaine (22ml of 0.2%) with saline (2ml) in TPVB respectively, along with general anesthesia. Patients were monitored and observed postoperatively for pain using VAS score, analgesic requirement and postoperative nausea and vomiting (PONV). Results: Demographic, preoperative and intraoperative vital parameters were comparable between the two groups. Total dose of propofol intraoperatively was less in RD group (30.33 ±1.07, 60.23 ± 3.31, 172.31.P<0.001. Time to first analgesia was significantly more in RD group (335 ± 31, 172.31 ± 10.31. p<0.001, Postoperative analgesic requirement of tramadol was lower in RD group (135.2 ± 3.31, 276.3 ± 7.11mg; P<0.001) and incidence of PONV (6.67%, 10.34%) was lower in RD group as compared to RS group. Conclusion: TPVB can be used as suitable alternative to GA as the anesthetic procedure in elective breast surgeries as it has proved to be an excellent analgesia in the postoperative period and has shown low rate of serious complications, along with potential for early ambulation and home discharge,