Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy

Rukewe, Ambrose; Afuwape, Oludolapo O; Ugheoke, A; Fatiregun, Akinola Ayoola

doi:10.2147/lra.s116102

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…A randomized control trial validated the use of USG for paravertebral block to increase the accuracy of PVB to 100%. This retrospective study describes the use of propofol based total intra-venous anaesthesia in addition to PVB intraoperatively which improved post-operative analgesia, quality of recovery and expedites discharge [10]. The addition of pectoral nerve blocks have been shown to improve efficacy of PVB as compared to only giving PVB [11,12].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study

Wagh¹,

Pendalya²,

Nadkarni³

2022

IJRA

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Introduction: Modified radical mastectomy (MRM) or breast conservative surgery (BCS) done under general anaesthesia (GA) in high-risk patients may be associated with significant morbidity, Intensive Care Unit stay and increased hospital stay leading to cost issues. In this case-series, we describe our experience with regional anesthesia for MRM or BCS and sentinel / complete axillary clearance in 61 patients with breast carcinoma who were high risk for perioperative complications in view of their co-morbidities. None required ICU or increased hospital stay postoperatively. Material & Methods: Sixty-one ASA III/IV patients operated under regional anaesthesia for carcinoma of the breast were included. Multiple level USG guided thoracic paravertebral block (PVB), PECS block (1/2), Pecto-intercostal fascial block (PIFB), Serratus-anterior plane block (SAPB), brachial plexus block, Superficial cervical plexus blocks (SCPB), Erector spinae block (ESB) were given in different combinations. Result: There were 60 female patients (Age: 30-97 years) and 1 male patient (59 years) (Left side -27 patients, right side- 34 patients). Of the total 61 patients, 23 patients underwent BCS with axillary dissection, 36 patients underwent MRM with axillary dissection, 2 patients had MRM with Pectoralis Major muscle resection. Patients received different combinations of blocks PVB or ESB, PECS1/2 and SAPB. 43 patients received the PVB, 61 got the PECS1/2, 12 patients received ESP, 32 patients required SCPB, 1 infra-clavicular block and 35 patients got PIFB. All procedures were completed under regional anaesthesia with 51 patients getting intravenous midazolam (0.01-0.02mg/kg), 59 patients were given IV fentanyl (1-3ug/kg , 43 patients were given IV propofol (1-2mg/kg), These were given in small aliquots during the duration of the procedure. 2 patients had IV ketamine (0.5mg/kg) and 1 patient had IV dexmeditomidine (0.2-0.3ug/kg/hr). IV paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDS) ie. Inj Diclofenac Sodium IV in the dose of 1mg/kg (max 75mg) were given when not contraindicated. There was single case of axillary hematoma with no other complications. No patient required ICU care postoperatively and were discharged as routine. Conclusion: A combination of blocks may be an option for surgical anaesthesia for breast surgeries in high risk patients. Careful planning, patient counseling and attention to toxic dose of local anaesthetics must always be considered. Keywords: Paravertebral block, Thoracic wall blocks, PECS block, Serratus Anterior plane block, Pecto-intercorstal fascial block, Superficial cervical plexus, Modified radical mastectomy, Breast conservative surgery.

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Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study

Wagh¹,

Pendalya²,

Nadkarni³

2022

IJRA

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“…In Nigeria, successful use of thoracic epidural anesthesia for major abdominal surgeries was reported in Uyo where two out of the twelve patients had total spinal anesthesia and were resuscitated [14]. Single shot lamina thoracic paravertebral block technique has been used as an adjunct to general anesthesia for modified radical mastectomy [15]. The experience of another researcher in Nigeria is also highlighted [16].…”

Section: Introductionmentioning

confidence: 99%

Management of Inadvertent Dural Puncture Following Thoracic Epidural anesthesia for Mastectomy: A Case Report

Nkadam,

Imasuen,

Ijah

2024

IJTDH

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Background: Thoracic Epidural has been successfully used to administer anesthesia for mastectomy. However inadvertent dural puncture is a major complication occurring in about 0.19 to 3.6% during epidural anesthesia, even in very experienced hands with need for immediate and proper management. We present a case of mastectomy done under thoracic epidural anesthesia following inadvertent dural puncture, using same interspace. Case Presentation: A 62-year-old known hypertensive female patient with good drug compliance, weighing 68kg and 1.68m in height with stage IV right breast cancer. She underwent modified radical right mastectomy, under thoracic epidural anesthesia administered at the T8/T9 interspace using an 18G Tuohy needle. Although there was inadvertent dural puncture, patient recovered without untoward effects. Conclusion: Epidural anesthesia can be undertaken in the same interspace following accidental dural puncture if necessary precautions are taken.

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Analgesic and Opioid Sparing Effects of Preoperative Thoracic Paravertebral Block

Okoye¹,

Majekodunmi²,

Ilori³

2021

Nigerian Postgraduate Medical Journal

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Background: Various regional anaesthetic techniques are used for post-mastectomy pain relief; however, thoracic paravertebral block (TPVB) has shown some advantages over other methods. This study sought to demonstrate the post-operative benefit of pre-operative TPVB in patients scheduled for simple mastectomy. Methods: The study was carried out on 60 adult female patients with the American Society of Anesthesiologists physical status Class I to III scheduled for unilateral mastectomy. Pre-operatively, a nerve stimulator was used to locate the paravertebral space thereafter bupivacaine with adrenaline or saline was injected into the space. Post-operatively, intravenous morphine patient controlled analgesia was commenced in the two groups for 24 h after the surgery. In addition, intravenous paracetamol 15 mg/kg was administered 6 hourly for 24 h in both groups. Results: The 24 h morphine consumption was significantly reduced in the bupivacaine group compared to the control group (P = 0.000). The Numerical pain rating score was significantly lower in the bupivacaine group than in the control group in the 1st 6 h; P = 0.001. The time to first request for analgesia was significantly longer in the bupivacaine group than the control group (P = 0.000). Nausea was the major side effect detected and this was significantly higher in the control group (P = 0.024). The morphine sparing effect was 65.7% in the bupivacaine group. Conclusion: The study showed that bupivacaine-based TPVB provided an effective post-operative analgesic and opioid-sparing effect for simple mastectomy when compared with a saline-based control group that received only intravenous morphine patient controlled analgesia and paracetamol.

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Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy

Cited by 3 publications

References 15 publications

Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study

Ultrasound Guided Regional Anaesthesia for Breast Surgery in High Risk Patients- A Retrospective Observational Study

Management of Inadvertent Dural Puncture Following Thoracic Epidural anesthesia for Mastectomy: A Case Report

Analgesic and Opioid Sparing Effects of Preoperative Thoracic Paravertebral Block

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