A comparative randomized study of paravertebral block versus wound infiltration of bupivacaine in modified radical mastectomy

Abstract

Background:Paravertebral block (PVB) has the potential to offer long-lasting pain relief because it can uniquely eliminate cortical responses to thoracic dermatomal stimulation. Benefits include a reduction in postoperative nausea and vomiting (PONV), prolonged postoperative pain relief, and potential for ambulatory discharge.Aims:To compare PVB with local infiltration for postoperative analgesia following modified radical mastectomy (MRM).Methods:Forty patients undergoing MRM with axillary dissection were randomly allocated into two groups. Following induction of general anesthesia in group P, a catheter was inserted in the paravertebral space and 0.3 ml/kg of 0.25 % of bupivacaine was administered followed by continuous infusion, while in group L, the surgical incision was infiltrated with 0.3 ml/kg of 0.25 % bupivacaine.Statistical Analysis:The statistical tests were applied as unpaired student ‘t’ test/nonparametric test Wilcoxon Mann Whitney test for comparing different parameters such as VAS score and consumption of drugs. The categorical variables such as nausea and vomiting scores, sedation score, and patient satisfaction score were computed by Chi square test/Fisher exact test.Results:VAS score was significantly lower in group P than in group L throughout the postoperative period. The mean alertness score (i.e., less sedation) was higher in group P in the postoperative period than group L. The incidence of PONV was less in PVB group.Conclusion:PVB at the end of the surgery results in better postoperative analgesia, lesser incidence of PONV, and better alertness score.

Analgesia in patients with or without single-shot lamina thoracic paravertebral block following breast cancer surgery in a Nigerian hospital

“…8 Our results of optimal pain control with TPVB are in agreement with the findings of previous studies which showed that TPVB was an effective option for postoperative analgesia and its use obviated the need for epidural block as well as systemic opioids thereby avoiding side effects associated with these therapeutic modalities. 5,8,14,15 TPVB patients reported less pain than their no-block counterparts; there was significant difference in the VRS until 24 h postoperatively. The pain relief was so profound that no patient in the TPVB group required opioid and non-opioid analgesic within 24 h. This observation differs from results of single-shot multi-level TPVBs in which significant differences in pain scores, opioid analgesic consumption lasted 6-8 h. 16,17 Our explanation for this difference is that in the lamina TPVB technique, the catheter that is tunneled into the TPVS allows the injection of a higher LA volume which engenders a better cranio-caudal spread than the multi-level classical approach.…”

“…Thoracic paravertebral block (TPVB) has been shown to provide prolonged postoperative pain relief for unilateral breast operations. 4,5 Consequently, our team began performing single-shot TPVB using the new lamina approach as an adjunct to general anaesthesia (GA) for major breast surgery. 6 To the best of our knowledge, no study has investigated the effectiveness of single-shot lamina TPVB.…”

Regional blocks for pre-emptive anti-emesis

“…[1] that presents the critical and innovative perspective of peri-anesthesia management. It has been my subjective understanding based on my observations that the surgical handling and stimulation of the eye globe, breasts and testicles elicit nauseating responses in the patients.…”

“…Additionally, these responses cannot be blocked with postoperative regional blocks as the physiological changes and reflexive mechanisms have been initiated to varying degrees intraoperatively that will present as PONV in pre-emptively untreated patients. [1] As wound infiltrations and surgical field/incision local anesthetic blocks can only be accomplished at the end of the surgeries, the clinically significant pre-emptive anti-emesis can only be achieved with pre-incision paravertebral/epidural blocks for mastectomies and pre-incision caudal/epidural/spinal/spermatic cord blocks for adult or pediatric testicular surgeries; however, peri-bulbar/retro-bulbar blocks for eye-muscle surgeries may have a concern for counter-productive surgical results in terms of the inadequate corrections of heterotropia. In summary, the observations of Bansal et al .…”

“…In summary, the observations of Bansal et al . [1] present a landmark research that will instigate the initiatives for regional nerve blocks in high-risk surgeries as a pre-emptive anti-emetic technique relegating the analgesia achieved as a secondary gain from these blocks.…”