ABSTRACT
BACKGROUND: Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. OBJECTIVE: With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. METHODS: Forty ASA I-II female patients aged 18-65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. RESULTS AND CONCLUSIONS: Mean seroma formation at postoperative 24th hour was 112.5±53.3 mL in the control group and 74.5±47.4 mL in the TPVB group (p=0.022). NRS scores were similar between two groups (p=0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6±4 mg in the TPBV group, and 16.6±6.9 mg in the control group (p <0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.
Subject(s)
Breast Neoplasms/surgery , Mastectomy , Nerve Block/methods , Postoperative Complications/prevention & control , Seroma/prevention & control , Adolescent , Adult , Aged , Double-Blind Method , Female , Humans , Lymph Node Excision , Middle Aged , Prospective Studies , Spinal Nerves , Young AdultABSTRACT
Abstract Background: Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. Objective: With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. Methods: Forty ASA I-II female patients aged 18-65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. Results and conclusions: Mean seroma formation at postoperative 24th hour was 112.5 ± 53.3 mL in the control group and 74.5 ± 47.4 mL in the TPVB group (p = 0.022). NRS scores were similar between two groups (p = 0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6 ± 4 mg in the TPBV group, and 16.6 ± 6.9 mg in the control group (p < 0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.
Resumo Introdução: Observa-se aumento do número de pacientes submetidos à cirurgia por neoplasia mamária. Seroma é a mais frequente complicação pós-operatória que aumenta a morbidade. Há muito tempo, considera-se o Bloqueio Paravertebral Torácico (BPVT) a técnica padrão-ouro para o controle da dor pós-operatória. O BPVT provoca, igualmente, o bloqueio da inervação simpática. Objetivo: Identificar o efeito do BPVT na redução de seroma em pacientes que realizaram mastectomia e dissecção dos linfonodos axilares. Método: Foram incluídas no estudo 40 pacientes do sexo feminino ASA I-II, entre 18 e 65 anos de idade, submetidas a mastectomia eletiva unilateral com ressecção de linfonodos axilares. As pacientes foram randomizadas em grupo BPVT e grupo controle. As pacientes do grupo BPVT foram submetidas ao BPVT guiado por ultrassom no nível de T1 e 20 mL de bupivacaína 0,25% foram administrados antes da cirurgia. Bomba de infusão IV ACP foi prescrita para todas as pacientes. Na 24ª hora pós-operatória foram registradas a quantidade de produção de seroma, o consumo de morfina e a avaliação da dor pela escala de avaliação numérica (NRS - do inglês Numeric Rating Scale). Resultados: A quantidade média de seroma na 24ª hora pós-operatória foi 112,5 ± 53,3 mL no grupo controle e 74,5 ± 47,4 mL no grupo BPVT (p = 0,022). Na 24ª hora pós-operatória a pontuação NRS foi semelhante nos dois grupos (p = 0,367), porém o consumo médio de morfina foi 5,6 ± 4 mg no grupo BPVT e 16,6 ± 6,9 mg no grupo controle (p < 0,001). Conclusões: O BPVT reduz a quantidade de seroma enquanto proporciona analgesia efetiva em pacientes que se submetem a mastectomia e remoção dos linfonodos axilares.
Subject(s)
Postoperative Complications/prevention & control , Breast Neoplasms/surgery , Seroma/prevention & control , Mastectomy , Nerve Block/methods , Spinal Nerves , Double-Blind Method , Prospective Studies , Lymph Node Excision , Middle AgedABSTRACT
STUDY OBJECTIVE: Erector spinae plane (ESP) block is a novel regional anesthesia technique and gaining importance for postoperative pain management. Since it was first described, the clinicians wonder if this new simple technique can replace paravertebral block (PVB). We aimed to compare the postoperative analgesic effect of ESP block and PVB with a control group in breast surgeries. DESIGN: Randomized controlled trial. SETTING: Operating room. PATIENTS: Seventy-five ASA I-II patients aged 25-65, who were scheduled to go under elective unilateral breast surgery for breast cancer were included to the study. INTERVENTIONS: Patients were randomized into three groups as ESP, PVB, and Control group. Ultrasound (US) guided ESP block and PVB with 20â¯ml 0.25% bupivacaine was done preoperatively to the patients according to their groups. MEASUREMENTS: All patients were provided with iv patient-controlled analgesia device for postoperative analgesia. Morphine consumptions and numeric rating scale (NRS) scores for pain were recorded at 1st, 6th, 12th and 24th hours postoperatively. MAIN RESULTS: There was a statistically significant difference between ESP and Control groups (pâ¯<â¯0,001) and between PVB and Control groups (pâ¯<â¯0,001), while there was no difference between ESP and PVB groups (pâ¯>â¯0,05) for 24-hour morphine consumptions. There was a significant difference between PVB and Control groups for NRS at postoperative 1st and 6th hour (pâ¯=â¯0.018 and pâ¯=â¯0.027 respectively). CONCLUSIONS: This study has shown that US guided ESP block and PVB provided adequate analgesia in patients undergoing breast surgery and have an opioid sparing effect by reducing morphine consumption. Clinical Trials Registry: NCT03480958.
Subject(s)
Analgesia, Patient-Controlled/statistics & numerical data , Analgesia/methods , Mastectomy/adverse effects , Nerve Block/methods , Pain, Postoperative/therapy , Administration, Intravenous , Adult , Aged , Analgesia/adverse effects , Analgesia, Patient-Controlled/methods , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Breast Neoplasms/surgery , Bupivacaine/administration & dosage , Bupivacaine/adverse effects , Cross-Over Studies , Female , Humans , Middle Aged , Morphine/administration & dosage , Morphine/adverse effects , Nerve Block/adverse effects , Pain Measurement/statistics & numerical data , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Paraspinal Muscles/diagnostic imaging , Paraspinal Muscles/innervation , Postoperative Nausea and Vomiting/epidemiology , Postoperative Nausea and Vomiting/etiology , Postoperative Nausea and Vomiting/prevention & control , Thoracic Vertebrae/diagnostic imaging , Ultrasonography, InterventionalABSTRACT
STUDY OBJECTIVE: To evaluate the analgesic effect of ultrasound-guided erector spinae plane (ESP) block in breast cancer surgery. DESIGN: Randomized controlled, single-blinded trial. SETTING: Operating room. PATIENTS: Fifty ASA I-II patients aged 25-65 and scheduled for elective breast cancer surgery were included in the study. INTERVENTIONS: Patients were randomized into two groups, ESP and control. Single-shot ultrasound (US)-guided ESP block with 20â¯ml 0.25% bupivacaine at the T4 vertebral level was performed preoperatively to all patients in the ESP group. The control group received no intervention. Patients in both groups were provided with intravenous patient-controlled analgesia device containing morphine for postoperative analgesia. MEASUREMENTS: Morphine consumption and numeric rating scale (NRS) pain scores were recorded at 1, 6, 12 and 24â¯h postoperatively. MAIN RESULTS: Morphine consumption at postoperative hours 1, 6, 12 and 24 decreased significantly in the ESP group (pâ¯<â¯0.05 for each time interval). Total morphine consumption decreased by 65% at 24â¯h compared to the control group (5.76⯱â¯3.8â¯mg vs 16.6⯱â¯6.92â¯mg). There was no statistically significant difference between the groups in terms of NRS scores. CONCLUSIONS: Our study findings show that US-guided ESP block exhibits a significant analgesic effect in patients undergoing breast cancer surgery. Further studies comparing different regional anesthesia techniques are needed to identify the optimal analgesia technique for this group of patients.