SINGLE NEEDLE THORACIC PARAVERTEBRAL BLOCK AS AN ALTERNATIVE TO GENERAL ANESTHESIA FOR MODIFIED RADICAL MASTECTOMY OPERATION : A RANDOMISED CONTROL STUDY

2021 ◽  
pp. 26-29
Author(s):  
Archana Roy ◽  
Pratibha Bhunia ◽  
Sampriti Sadhukhan ◽  
Dipankar Mukherjee ◽  
Shrawan Soni
Keyword(s):  
Blood Loss ◽  
Epidural Catheter ◽  
Radical Mastectomy ◽  
Paravertebral Block ◽  
Anaesthetic Technique ◽  
Paravertebral Space ◽  
Early Ambulation ◽  
Thoracic Paravertebral Block ◽  
Haemodynamic Changes ◽  
Unilateral Block

Background and Aims: Conventionally, surgery for breast carcinoma is done under general anaesthesia (GA). Recently thoracic paravertebral block (TPVB) is gaining popularity because it produces unilateral block and minimal haemodynamic changes. It also facilitates post-op analgesia, early ambulation, and reduces hospital stay. Aim was to observe effectiveness of single needle TPVB with bupivacaine as the sole anaesthetic technique for Modied radical mastectomy (MRM). Methods: 60 consenting female patients of ASA I & II, aged 18-60 years scheduled for modied radical mastectomy were randomly assigned into two groups: Gr. P (n=30), Gr. G(n=30). For Gr. P: TPVB was given at T4 vertebral level with 18G Tuohy needle and an epidural catheter inserted 2- 3cm inside the paravertebral space. Bupivacaine 0.5% isobaric 15-20ml (not exceeding 2 mg/kg b.w.) injected through the epidural catheter. Dexmedetomidine infusion given for sedation. Gr. G: GA was given with Midazolam, Fentanyl, Propofol and Atracurium. Measured parameters were baseline and intraoperative haemodynamics , induction time, recovery time, fentanyl requirement, average blood loss, post-op pain score by VAS at 0,1/2,1,2,4,8,12,24hrs, duration of analgesia, patient and surgeon satisfaction scores(PSS,SSS),and incidence of post-op nausea vomiting(PONV). RESULTS: Group P patients had prolonged induction ( ) and recovery was faster ( ) in comparison to 12.25±3.66 1.61±0.69 group G. Intraoperatively Group P patients required less Fentanyl & also had less blood loss. Post op VAS score, incidence of PONV were more in group G. Conclusion: TPVB may be used as an alternate anaesthetic technique for MRM as it provides adequate analgesia both in intra and post op period with minimal adverse effects.

scholarly journals Effects of Catheter Tip Location on the Spread of Sensory Block Caused by a Continuous Thoracic Paravertebral Block: A Prospective, Randomized, Controlled, Double-Blind Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Takayuki Yoshida ◽  
Yoshiko Watanabe ◽  
Takeshi Hashimoto ◽  
Atsushi Ohta ◽  
Tatsuo Nakamoto
Keyword(s):  
Sensory Block ◽  
Paravertebral Block ◽  
Posterior Region ◽  
Anterior Region ◽  
Parietal Pleura ◽  
Double Blind Study ◽  
Paravertebral Space ◽  
Double Blind ◽  
Thoracic Paravertebral Block ◽  
Group A

Single injections in the anterior region of the thoracic paravertebral space (TPVS) have been reported to generate a multisegmental longitudinal spreading pattern more frequently than those in the posterior region of the TPVS. In this trial, we examined the hypothesis that a continuous thoracic paravertebral block (TPVB) administered through a catheter inserted into the anterior region of the TPVS allows a wider sensory block dispersion. Fifty consecutive patients undergoing video-assisted thoracic surgery were enrolled. Before the surgery, an infusion catheter was inserted into the TPVS through a needle placed adjacent to either the parietal pleura (group A) or internal intercostal membrane (group P) using an ultrasound-guided intercostal transverse approach according to a randomized allocation schedule. A chest radiograph was obtained postoperatively after injection of 10 mL of radiopaque dye through the catheter. Thereafter, 20 mL of 0.375% levobupivacaine was injected via the catheter, followed by commencement of continuous TPVB with 0.25% levobupivacaine at 8 mL/h. The primary outcome was the number of blocked dermatomes at 24 h after surgery. The secondary outcomes included radiopaque dye spreading patterns, the number of segments reached by the radiopaque dye, the number of blocked dermatomes at 2 h after surgery, and pain scores. The median (interquartile range [range]) number of blocked dermatomes 24 h after surgery was 3 (2.75–4 [1–6]) in group A (n = 22) and 2 (1.5–3 [0–7]) in group P (n = 25; p = 0.037). No significant differences in the other outcomes were found between the groups. In conclusion, a continuous TPVB administered using a catheter supposedly inserted into the anterior region of the TPVS allows a wider sensory block dispersion than a catheter inserted into the posterior region of the TPVS. This trial is registered with the UMIN Clinical Trials Registry (UMIN000018578).

scholarly journals Thoracic paravertebral block for analgesia after modified radical mastectomy

2014 ◽  
Vol 28 (3) ◽  
pp. 160 ◽  
Author(s):  
LeenaP Patel ◽  
BipinM Patel ◽  
GauravC Prajapati ◽  
PritiR Sanghvi ◽  
MishaB Agarwal
Keyword(s):  
Radical Mastectomy ◽  
Paravertebral Block ◽  
Modified Radical Mastectomy ◽  
Thoracic Paravertebral Block

scholarly journals Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study

2019 ◽  
Vol Volume 12 ◽  
pp. 2701-2708 ◽  
Author(s):  
Domenico P Santonastaso ◽  
Annabella de Chiara ◽  
Emanuele Russo ◽  
Giovanni Musetti ◽  
Leonardo Lucchi ◽  
...  
Keyword(s):  
Free Radical ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Radical Mastectomy ◽  
Paravertebral Block ◽  
Single Shot ◽  
Ultrasound Guided ◽  
Thoracic Paravertebral Block

Single-injection caudal thoracic paravertebral block improves pain control and recovery quality in female dogs undergoing unilateral radical mastectomy: a randomized controlled trial

2021 ◽  
Vol 260 (S1) ◽  
pp. S53-S58
Author(s):  
Francesco Santoro ◽  
Pasquale Debidda ◽  
Paolo Franci
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Single Injection ◽  
Radical Mastectomy ◽  
Cardiovascular Responses ◽  
Paravertebral Block ◽  
Control Groups ◽  
Thoracic Paravertebral Block ◽  
Pain Scores ◽  
And Control

Abstract OBJECTIVE To test clinical and analgesic effects of a single-injection caudal thoracic paravertebral block (TPVB) after localization of the thoracic paravertebral space with a loss-of-resistance to air injection technique in female dogs undergoing unilateral radical mastectomy. ANIMALS 14 client-owned dogs. PROCEDURES Dogs were premedicated with methadone, anesthetized with propofol and sevoflurane, and randomly assigned to receive a TPVB or no block preoperatively. Rescue analgesia with fentanyl and methadone was provided on the basis of cardiovascular responses during surgery and postoperative pain scores assigned with a validated pain scale. Required dose of rescue opioids; mean end-tidal sevoflurane concentration; episodes of hypotension, bradycardia, and other complications; quality of recovery scores; and postoperative pain scores were compared between groups. RESULTS Median intraoperative fentanyl doses were 0 µg/kg (range, 0 to 2 µg/kg) and 4 µg/kg (range, 2 to 6 µg/kg) for the TPVB and control groups, respectively. Median postoperative methadone doses were 0 mg/kg (range, 0 to 0.2 mg/kg) and 0.6 mg/kg (range, 0.4 to 0.6 mg/kg) for the TPVB and control groups, respectively. Recovery scores and pain scores assigned at the time of and 1 hour after extubation were significantly lower in the TPVB group than in the control group. CONCLUSIONS AND CLINICAL RELEVANCE A single-injection caudal TPVB improved pain control and recovery quality in female dogs undergoing unilateral radical mastectomy. Because the TPVB involves only a single injection, does not take long to perform, and requires only readily available low-cost equipment, the technique may be a valuable option in both referral and first-opinion practice.

Sign in / Sign up

Export Citation Format

Share Document