Single-injection paravertebral block before general anaesthesia enhances analgesia after breast cancer surgery with associated lymph node biopsy

Kairaluoma, P.; Bachmann, M.; Korpinen, A.; Rosenberg, P. H.; Péré, P.

doi:10.1097/00003643-200406002-00383

Cited by 4 publications

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“…A sample size estimate indicated that 30 patients per group would give a power of 80% at the level of 0.05 for detecting a difference of 38% in oxycodone consumption between the control and paravertebral groups (mean consumption, 10.2 ± 5.8 vs. 6.0 ± 4.9 mg) using the t-test. The power analysis was based on our previous study investigating opioid sparing using single-injection paravertebral block in conjunction with breast cancer surgery [16,17]. The number of patients was thus prospectively set at 60, with 30 patients assigned to each treatment group.…”

Section: Methodsmentioning

confidence: 99%

Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study

et al. 2008

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Section: Methodsmentioning

confidence: 99%

Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study

et al. 2008

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“…Our result can be supported by Hura G and colleagues 8 who found significant dermatomal blockade in ropivacaine group to perform another surgery after 24 hrs. Kairaluoma PM and colleagues 21 studied the effect of single-injection paravertebral block before general anaesthesia on postoperative pain and postoperative nausea and vomiting (PONV) after breast surgery and found that patients given PVB with bupivacaine had less postoperative pain, as indicated by longer times to first analgesic dose, lower VAS scores, and 40% smaller oxycodone consumption in the PACU. PVB reduced the opioid demand statistically significantly (P < 0.05).…”

Section: Resultsmentioning

confidence: 99%

Single injection thoracic paravertebral block for mastectomy operation: a comparative study between ropivacaine and bupivacaine

Ghosh¹

2019

jmscr

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In recent years, regional anaesthetic techniques are being preferred as an adjuvant to general anaesthesia for the relief of postoperative pain. Breast surgeries are widely performed for cosmetic as well as oncological reasons and are associated with severe pain, PONV and respiratory complications due to inadequate pain relief. The present study was carried out to compare the efficacy of bupivacaine and ropivacaine in a single injection paravertebral block for controlling the postoperative pain after an elective breast surgeries. Method: Seventy-two female patients scheduled for elective breast surgery were randomized into two groups; R (Ropivacaine group) and B (bupivacaine group), 36 patients were allotted to each group. Both the groups received single injection paravertebral block with either of the drug. Surgery was conducted under general anaesthesia in both the groups. Intensity of postoperative pain was measured by VAS score at 2, 4, 6, 9, 12, 18 and 24 hrs. Intensity of pain and the analgesic consumption over the past 24 hours were recorded. Duration of postoperative analgesia was calculated by the time of first analgesic requirement. Results: VAS scores in the immediate postoperative period that is 2-12 hrs. were comparable between both the groups (p> 0.05), however the VAS score at 9, 18 and 24 hours were significantly higher in group R. Fentanyl consumption in the first 24 hours was 68.06±23.612µg for the group R as compared to 76.39±17.87µg for the group B which is statistically insignificant. The time to request for 1st analgesic was 646.56±115.85min in the group R and 609.25±75.02mins in the group B (p>0.05) which is also statistically insignificant. Conclusion: Ropivacaine and Bupivacaine both provide good quality of analgesia after single injection thoracic paravertebral block in breast surgeries.

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“…Local anaesthetic (LA) deposited here results in multidermatomal, ipsilateral, sensory and sympathetic block [11]. Commonly a single injection ipsilateral paravertebral block performed at T3-T4 level with injection of 15-20 ml of LA has been used for providing analgesia for breast surgery as an adjunct to GA [12]. Single injection TPVB has also been used to provide anaesthesia for breast surgery [13,14].…”

Section: Thoracic Paravertebral Block (Tpvb)mentioning

confidence: 99%

Regional Anaesthesia for Breast Surgery

2021

IJRA

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Innervation of the breast:nd thThe breast receives innervation mainly from the 2 to 6 thoracic (T2-6) spinal nerves. The thoracic spinal nerves after emerging from the intervertebral foramina divide into dorsal and ventral ramii [1]. The dorsal ramii provide innervation to the skin and the muscles of the medial back. Each ventral ramus continues anteriorly as an intercostal nerve, accompanied by an intercostal artery and vein lying between the innermost and the internal intercostal muscle along the inferior borders of the respective ribs.Near the midpoint of the hemithorax corresponding to the midaxillary line, each intercostal nerve gives a lateral cutaneous branch that further divides into an anterior and posterior branch. Sensory supply of lateral aspect of breast is provided by the anterior divisions of the lateral cutaneous branches of T2-T6 intercostal nerves with contributions from T1 and T7 nerves. The intercostal nerves interconnect providing overlapping nerve supply to the breast. The main intercostalnerve continues anteriorly and terminates as an anterior cutaneous branch that further divides into a medial and lateral divisions which provide cutaneous innervation over the sternum and medial part of the breast respectively [2-4] (Figure 1) [5].The intercostobrachial nerve (T2) mainly provides cutaneous innervation to the axillary tail of the breast, the axilla, and the medial upper arm. The medial cutaneous nerve of the arm (branch of the brachial plexus) may also supply the roof of the axilla and may receive contributions from T1 and T3 nerves. The supraclavicular nerves of the cervical plexus provide sensory supply to the infraclavicular or supramammary area [6, 7], (Figure 1). The muscles of chest wall underlying the breast, the pectoralis major (PMM) and pectoralis minor (PmM) are innervated by mixed motor and sensory nerves, the lateral pectoral nerves (LPN) (C5-7, lateral cord) and the medial pectoral nerves (MPN) (C7-T1, medial cord), branches of the brachial plexus. These nerves also possess proprioceptive and nociceptive fibres and thus traction, stretching or muscle spasm of these muscles can lead to dull, aching perioperative pain. In addition, the long thoracic nerve (LTN) (C5-7) and the thoracodorsal nerve (TDN) (C6-8, posterior cord) branches of the brachial plexus innervate the serratus anterior (SAM) and the latissimus dorsi (LD) muscles, that form part of the axilla [8]. Therefore, the breast, axilla and the surrounding tissues are supplied by interconnected network of T2-T6 intercostal nerves, branches of the brachial plexus and the lower branches of the cervical plexus (Figure 1) [5].Regional anaesthesia blocks used for Breast surgery: These blocks will be decribed starting from the older, posteriorly performed blocks to the newer, superficial antero-lateral chest wall blocks for breast surgery. Thoracic Epidural Anaesthesia (TEA)Thoracic epidural block performed at T4 has been used to provide segmental anaesthesia and analgesia extending from C8-T6 for breast surgery.Advantages of TE...

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Single-injection paravertebral block before general anaesthesia enhances analgesia after breast cancer surgery with associated lymph node biopsy

Cited by 4 publications

References 0 publications

Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study

Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study

Single injection thoracic paravertebral block for mastectomy operation: a comparative study between ropivacaine and bupivacaine

Regional Anaesthesia for Breast Surgery

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