Comparison of efficacy of ultrasound-guided pectoral nerve block versus thoracic paravertebral block using levobupivacaine and dexamethasone for postoperative analgesia after modified radical mastectomy: A randomized controlled trial

Ashwini Siddeshwara, Geeta Singariya, Manoj Kamal, Kamlesh Kumari, Satyanarayan Seervi, Rakesh Kumar, Ashwini Siddeshwara, Geeta Singariya, Manoj Kamal, Kamlesh Kumari, Satyanarayan Seervi, Rakesh Kumar

Abstract

Background and aims: Pectoral nerve (PecS II) block is the latest modality for providing postoperative analgesia after breast surgery. The present study was planned to compare the analgesic efficacy of thoracic paravertebral block (TPVB) and PecS II for postoperative analgesia after modified radical mastectomy (MRM).

Methods: A total of 40 female patients undergoing radical mastectomy were randomly allocated into two groups (n = 20). Group T received ultrasound-guided TPVB, while group P received PecS II block using 0.25% levobupivacaine 24 ml + dexamethasone 1 ml (4 mg) before induction of anesthesia. The primary outcome was duration of analgesia (time to request first analgesic dose), while total rescue analgesic consumption in first 24 h, numeric rating score (NRS), and complication were secondary outcomes. The data were analyzed using IBM SPSS software version 22.0.

Results: The duration of analgesia was significantly prolonged in the group P than group T (474.1 ± 84.93 versus 371.5 ± 51.53 min, respectively; P < 0.0001). Postoperative morphine consumed at 24 h was less in the group P than group T (11.25 ± 4.75 and 15.0 ± 4.86 mg, respectively; P = 0.018). NRS at movement and rest were lower in the group P as compared to group T at all time intervals (median 3 versus 4). No block-related complication was recorded in any group.

Conclusions: The 0.25% levobupivacaine with dexamethasone 4 mg in PecS II block provided longer duration of analgesia than the TPVB in patients undergoing MRM without any adverse effects.

Keywords: Dexamethasone; levobupivacaine; modified radical mastectomy; paravertebral block; pectoral nerve block.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2019 Saudi Journal of Anesthesia.

Figures

Figure 1
Figure 1
Consort flow diagram of participants through each stage of randomized trial
Figure 2
Figure 2
Patient satisfaction score between two groups

References

    1. Jaffe SM, Campbell P, Bellman M, Baildam A. Post operative nausea and vomiting in women following breast surgery: An audit. Eur J Anaesthesiol. 2000;17:261–4.
    1. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Dworkin RH. Risk factors for chronic pain following breast cancer surgery: A prospective study. J Pain. 2006;7:626–34.
    1. Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302:1985–92.
    1. Bolin E.D, Harvey N.R, Wilson S.H. Current Anesthesiology Report. New York: Springer Science Media; 2015. Regional anaesthesia techniques and benefits.
    1. Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carlsson PS. Thoracic paravertebral block for breast cancer surgery: A randomized double-blind study. Anesth Analg. 2007;105:1848–51.
    1. Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: A meta-analysis of randomized controlled trials. Br J Anaesth. 2010;105:842–52.
    1. Blanco R. The pecs block: A novel technique for providing analgesia after breast surgery. Anaesthesia. 2011;66:847–8.
    1. Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of PecS II (Modified PecS I): A novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59:470–5.
    1. Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block v/s TPVB for postoperative analgesia after radical mastectomy, randomized controlled trial. Br J Anaesth. 2016;117:382–6.
    1. Wahba SS, Kamal SM. Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery. Egypt J Anaesth. 2013;30:129–35.
    1. El-Sheikh SM, Fouad A, Bashandy GM, Al-Azzb MA, Gamal RA. Ultrasound guided modified pectoral nerves block versus thoracic paravertebral block for perioperative analgesia in major breast surgery. Med J Cairo Univ. 2016;84:189–95.
    1. Syal K, Chandel A. Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy: A randomized double-blind trial. Indian J Anaesth. 2017;61:643–8.
    1. Hetta DF, Rezk KM. Pectoralis serratus interfascial plane block vs. thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation. J Clin Anaesth. 2016;34:91–7.
    1. Bashandy GMN, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: A randomized clinical trial. Reg Anesth Pain Med. 2015;40:68–74.
    1. Lönnqvist PA, Mackenzie J, Soni AK, Conacher ID. Paravertebral blockade: Failure rate and complications. Anaesthesia. 1995;50:813–5.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren