Safety and efficacy of multiple site thoracic paravertebral nerve block vs. modified pectoral nerve block for postoperative analgesia after modified radical mastectomies-a randomised controlled trial
Journal Title: Indian Journal of Clinical Anaesthesia - Year 2018, Vol 5, Issue 3
Abstract
This study compares the safety and efficacy of multiple level thoracic paravertebral block and modified Pecs block for postoperative pain relief after Modified Radical MastectomiesAfter Institutional Review Board IRB and Human Ethics Committee HEC approval the study was conducted on 41 patients who were scheduled to undergo modified radical mastectomy Written informed consent was taken Female patients in the age group of 1875 years who were ASA grade I and II were randomly allocated to two groups to either receive Ultrasound guided Thoracic paravertebral block TPVB at T2 and T4 levels Group 2 or an ultrasound guided modified PECS block Group 1 preoperatively in the block roomParavertebral block was given at two vertebral levels T2 10 ml and T4 level 10 ml under ultrasound guidance utilising the parasagital inplane technique Modified PEC block was administered to patients in the PEC group10 ml of 05 Ropivacaine for Pec1 and 20ml for Pec 2 In all patients surgery was done under GA Pain was assessed with Numerical Rating Scale NRS on a 0 to 10 scalefor 24 hours after surgery at 00511524612 and 24 hours after surgery by a blinded observerRescue opioid and Paracetamol requirement was recorded The patients were also monitored for any specific block related complicationsPrimary outcome measures were the numerical rating scores for pain and rescue analgesic requirement Secondary outcome measures was looking for any block related complications Demographic categorical variables were expressed in frequency and percentage and the continuous variables were reported in terms of mean and standard deviation The comparison of pain scores between the thoracic paravertebral nerve block and modified pectoral nerve block was done using MannWhitney U test Mean duration of analgesia and mean 24 hour Morphine Paracetamol consumption was compared using Student39s t testThere was no statistically significant difference between the two groups with respect to the pain scores at 00511524612and 24 hours at rest or with movement of the ipsilateral arm The 24 hour Morphine consumption was not also statistically significant pec gpmean 217 SD 109 tpvb gp mean 2 SD 077 p value 0752 Paracetamol consumption in the initial 24 hours after surgery was also not statistically significant between the two groups pec gp 368 and tpvb gp 50 patients received paracetamol with a p value of 0523 We found both the blocks modified Pecs and multiple level paravertebral block were equally effective in treating postoperative painKeywords Modified pectoral nerve block Multiple level thoracic paravertebral block Postoperative analgesia Modified radical mastectomy
Authors and Affiliations
Viji S Pillai, Bhagyalakshmi Ramesh, Silvy Anna Varughese
Keywords
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- EP ID EP476524
- DOI 10.18231/2394-4994.2018.0083
- Views 98
- Downloads 0
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