Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study

Li, Nai-Liang; Yu, Ben-Long; Hung, Chen‐Fang

doi:10.1371/journal.pone.0166227

Cited by 16 publications

(7 citation statements)

References 35 publications

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“…Таким чином, дія жодної з двох блокад не забезпечує аналгезію всієї ділянки хірургічного втручання на молочній залозі та аналгезія від блокад залежить від місця розміщення і поширеності розрізу, що для пекторальної блокади підтверджує дослідження D.H. Kim та співавт., де було виявлено більшу потребу в опіоїдах після операції при локалізації пухлини в медіальній половині молочної залози порівняно з латеральною [24]. Також краще знеболювання великих операцій, таких як мастектомія, забезпечується комбінацією ПВБ і ПБ порівняно з лише однією з них [25].…”

Section: таблиця 2 знеболювання активізація прийом їжі та понб після різних видів анестезіїunclassified

Efficacy of the pectoral nerve block type II and paravertebral block for enhanced recovery after breast cancer surgery

Martsiniv

2021

ЕМ

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Background. Breast cancer surgery is associated with severe postoperative pain and increased frequency of postoperative nausea and vomiting (PONV). It slows down patients’ mobilization in the postoperative period. Regional anesthesia provides better analgesia and can be part of enhanced recovery after surgery. The purpose of this study is to compare the efficacy of the pectoral nerve block type II, paravertebral block, and systemic analgesia concerning the opioids consumption, PONV, time to first food intake, and mobilization of patients in the perioperative period of breast cancer surgery. Materials and methods. Ninety-one adult women after unilateral radical mastectomy or quadrantectomy with axillary dissection were enrolled and randomized into three groups depending on the type of anesthesia. The control group included only patients with general anesthesia (GA), pectoral block group — GA plus pectoral nerve block type II with ropivacaine 0.375% 30 ml, and paravertebral block (PVB) group — GA plus thoracic paravertebral block with ropivacaine 0.5% 20 ml. The evaluated variables included opioids consumption during and after surgery, the occurrence of PONV, the time to the first feeding, and first mobilization in the postoperative period. Results. The dose of fentanyl during the operation was 2.6 (2.07‑3.62) μg/kg/h in the control group, 2.3 (1.86‑2.94) μg/kg/h in the PB group, 1.9 (1.62‑2.24) μg/kg/h in the PVB group (p = 0.003). Nine patients (31 %) in the control group, 8 patients (27 %) in the PVB group, and 6 patients (19 %) in the PB group required analgesia with promedol 2% after surgery (p = 0.542). The time to getting out of bed in the control, PB and PVB groups was 360 (150–360) min, 170 (120–240) min, and 162.5 (120–240) min, respectively (p = 0.003), and the time to the first meal was 360 (240–360) min, 165 (120–240) min, and 180 (120–220) min, respectively (p < 0.001). The incidence of PONV was the lowest in the PB group — 6 vs. 27 vs. 31 % in the PVB and control groups, respectively (p = 0.027). Conclusions. Among studied methods of analgesia in breast cancer surgery, the pectoral nerve block type II has the greatest advantages for enhanced recovery after surgery.

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Section: таблиця 2 знеболювання активізація прийом їжі та понб після різних видів анестезіїunclassified

Efficacy of the pectoral nerve block type II and paravertebral block for enhanced recovery after breast cancer surgery

Martsiniv

2021

ЕМ

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“…Thoracic epidural analgesia, intercostal nerve blockade, paravertebral blockade, and local infiltration are common methods of analgesia after MRM. However, each method has advantages and disadvantages (11)(12)(13)(14). As a result, less invasive strategies for regional analgesia are being investigated.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Ultrasound Guided-Deep Serratus Anterior Plane Blockade With Different Doses of Dexmedetomidine for Women Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial

Chen

Zhu

et al. 2022

Front. Med.

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BackgroundUltrasound guided-deep serratus anterior plane block (USG-DSAPB) has been used for pain management of patients undergoing modified radical mastectomy (MRM), but evidence supporting their adjuvant analgesic benefits is limited. We explored the efficacy and safety of preemptive use of ropivacaine combined with different doses of dexmedetomidine (DEX) in USG-DSAPB for patients undergoing MRM.MethodsNinety-five female patients undergoing unilateral MRM were allocated randomly to two groups. Group RD1 had 20 mL of 0.5% ropivacaine with 5 mg of dexamethasone and 0.5 μg·kg−1 DEX in USG-DSAPB. Group RD2 had 20 mL of 0.5% ropivacaine with 5 mg of dexamethasone and 1 μg·kg−1 DEX in USG-DSAPB. The primary outcome was sufentanil consumption 72 h after USG-DSAPB. Secondary outcomes were: postoperative pain scores and level of sedation; intraoperative hemodynamics; duration of post-anesthesia care unit (PACU) stay; prevalence of moderate-to-severe pain; one-time puncture success; procedure time of blockade; time to first rescue analgesia; requirement of rescue analgesia; satisfaction scores of patients and surgeons; duration of hospital stay; adverse events; prevalence of chronic pain; quality of postoperative functional recovery.ResultsCompared with the RD1 group, the visual analog scale score for coughing was significantly lower at 4, 8, 12 h and sufentanil consumption was significantly lower at 4, 8, 12, 24, and 48 h after surgery in the RD2 group (P < 0.05). The time to first rescue analgesia was significantly longer in the RD2 group (P < 0.05). The requirement for rescue analgesia was significantly higher in the RD1 group (P < 0.05). The prevalence of moderate-to-severe pain, number of patients using vasoactive agents, duration of PACU stay, as well as consumption of propofol, remifentanil, and DEX were significantly lower in the RD2 group (P < 0.05). There were no significant differences between the two groups with respect to one-time puncture success, procedure time of blockade, total dermatomal spread, satisfaction scores of patients and surgeons, postoperative complications, duration of hospital stay, 40-item Quality of Recovery questionnaire (QoR-40) score, or prevalence of chronic pain (P > 0.05).ConclusionsWe discovered that 1 μg·kg−1 (not 0.5 μg·kg−1) DEX combined with 20 mL of 0.5% ropivacaine and 5 mg of dexamethasone in USG-DSAPB could provide superior postoperative analgesia for patients undergoing MRM. However, the quality of postoperative functional recovery and prevalence of chronic pain were similar.Clinical Trial Registration:http://www.chictr.org.cn/showproj.aspx?proj=54929, identifier: ChiCTR2000033685.

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“…Based on the application of ultrasound (US), TPVB block has been used for anesthesia and has gained better abirritation during MRM. However, this technique is also limited by the complicated operation and severe postoperative complications such as hypotension, epidural or intrathecal spread, and pleural puncture (LI NL 2016).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Transversus Thoracic Muscle Plane-Pectoral Nerve Block for Postoperative Analgesia After Modified Radical Mastectomy: A Comparison with the Thoracic Paravertebral Nerve Block

Zhao

Jin

Pan

et al. 2021

Preprint

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Background: Modified radical mastectomy (MRM) is a most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain even last for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM.Methods: In this randomized controlled pilot trial, eighty female breast cancer patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n=40) or TPVB (TPVB group, n=40). The primary outcome was 24 h postoperative fentanyl consumption. Secondary outcome measures included intraoperative fentanyl and postoperative flurbiprofen axetil consumption, duration of analgesia, pain intensity at rest and during activity, inflammatory response, and the quality of recovery 40 (QoR-40) score.Results: Intraoperative fentanyl requirement was similar between the two groups; Postoperative fentanyl consumption was decreased in the TTP-PECS group copmared with the TPVB group, as well as the rate of postoperative flurbiprofen axetil consumption, but the duration of analgesia was longer; Pain scores at rest and during activity were dramatically decreased at postoperative 12 h; Moreover, the levels of IL-6, MCP-1 and TNF-α, as well as the levels of PGE2, NPY and β-endorphins were decreased at 12 h after surgery; Finally, the total QoR-40 score, especially for the scores of pain, emotional state and patient support were increased.Conclusion: Both TTP-PECS and TPVB are effective for analgesia after MRM. However, TTP-PECS reduced postoperative fentanyl and flurbiprofen axetil consumption in the first 24 h after MRM, and prolonged the duration of analgesia. Furthermore, TTP-PECS reduced postoperative pain intensity at rest and during activity, and inflammatory response at 12 h postoperation. Finally, TTP-PECS improved QoR-40 scores on the postoperative day. Thus, TTP-PECS is an attractive alternative to TPVB for postoperative analgesia after MRM.

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Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study

Cited by 16 publications

References 35 publications

Efficacy of the pectoral nerve block type II and paravertebral block for enhanced recovery after breast cancer surgery

Efficacy of the pectoral nerve block type II and paravertebral block for enhanced recovery after breast cancer surgery

Efficacy and Safety of Ultrasound Guided-Deep Serratus Anterior Plane Blockade With Different Doses of Dexmedetomidine for Women Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial

Ultrasound-Guided Transversus Thoracic Muscle Plane-Pectoral Nerve Block for Postoperative Analgesia After Modified Radical Mastectomy: A Comparison with the Thoracic Paravertebral Nerve Block

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