Evaluation of the hemodynamic effect of bupivacaine wound instillation in modified radical mastectomy
Journal Title: Medpulse International Journal of Anesthesiology - Year 2018, Vol 8, Issue 3
Abstract
Background and aim: Breast cancerare a leading cause of cancer death among women. Modified Radical Mastectomy (MRM) is the commonest surgery done for operable breast malignancies. Majority of operated patients will experience some degree of postoperative pain. Poorly managed postoperative pain may cause activation of the stress response leading to stress over several major organ. This study has been designed to determine hemodynamic effects of bupivacaine wound instillation for postoperative pain relief in patients undergoing MRM for cancer breast. Methods: In this comparative prospective randomized clinical study 66 patients aged 30–65years were divided into three groups D, S and C. All patients received general anesthesia.Axillary and chest wall drains were placed at the end of surgery. Group D received 40ml of 0.25% bupivacaine 20ml through each drain. Group S received 40ml of normal saline 20ml through each drain. Group C was the control with no installation. After instillation of study drug, the drains were clamped for period of 10mins. After extubation, pain score for pain was evaluated using visual analog scale and then 4thhourly till 24 hrs. Rescue analgesia was injection tramadol, if the VAS ≥4.The patient’s hemodynamic parameters were monitored postoperatively 4th hourly for 24 hrs. Statistical analysis was performed using software SPSS 18.0, and R environment ver.3.2.2. Result: the parameters monitored were pulse rate, mean arterial pressure and SpO2%. The mean of these hemodynamic parameters was calculated and compared with the other groups. It was found to be statistically not significant.Conclusion: The wound instillation of bupivacaine into surgical drain in modified radical mastectomy provides an effective post-operative analgesia with better hemodynamic stability and reduced adverse effect related to the drug and minimal or no complication associated with instillation of the drug.
Authors and Affiliations
Vinutha M, Rashmi NR, VB Gowda
Keywords
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