Post-operative pain and analgesic requirements after paravertebral block for mastectomy: A randomized controlled trial of different concentrations of bupivacaine and fentanyl

Abstract

Background:Paravertebral block (PVB) is useful for post-operative analgesia after breast surgery. Bupivacaine is used for PVB at higher concentrations (0.5%), which may lead to systemic toxicity after absorption. Therefore, we proposed to evaluate the efficacy of lower concentrations of bupivacaine with and without fentanyl for thoracic PVB in patients undergoing surgery for carcinoma breast.Methods:Forty-eight patients scheduled for surgery for breast cancer were enrolled in this prospective, randomized, double-blinded, placebo-controlled trial and were allocated to one of four groups: 0.25% bupivacaine with epinephrine 5 mcg/ ml, 0.25% bupivacaine + epinephrine 5 mcg/ ml with 2 mcg/ml fentanyl, 0.5% bupivacaine + epinephrine 5 mcg/ml or isotonic saline. PVB was performed and 0.3 ml/kg of the test drug was administered before induction of general anaesthesia. The primary outcome assessed was post-operative analgesic requirement for a period of 24 h. Secondary outcome measures were post-operative pain scores at rest and on movement of the arm, latency to first opioid, post-operative nausea and vomiting, quality of sleep, ability to move arm and patient satisfaction.Results:The patient characteristics and anaesthetic technique were comparable among the groups. The rescue analgesic consumption as well as cumulative pain scores at rest and on movement were significantly less in 0.25% bupivacaine+epinephrine with fentanyl and 0.5% bupivacaine+epinephrine groups (P<0.05). The average duration of analgesia was found to be 18 h after either 0.25% bupivacaine with epinephrine+fentanyl or 0.5% bupivacaine with epinephrine.Conclusions:Lower concentrations of bupivacaine can be combined with fentanyl to achieve analgesic efficacy similar to bupivacaine at higher concentrations, decreasing the risk of toxicity in PVB.

Paravertebral block using bupivacaine with/without fentanyl on postoperative pain after laparoscopic cholecystectomy: A double-blind, randomized, control trial

“…Reported studies[252627282930] shows different results on pain management and the difference in the results from our study could possibly be because of the difference in the nature of surgery, kind and dose of drugs, and the difference in the method of treatment.…”

Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review

“…Karakaya et al and Sert et al demonstrated prolongation of motor and sensory block as well as statistically significant increases in analgesic duration when fentanyl was added to bupivacaine [ 35 ] or articaine [ 36 ] axillary blocks without epinephrine. Bhuvaneswari et al found that addition of fentanyl to 0.25% bupivacaine plus epinephrine paravertebral blocks prolonged analgesia to 18 hours, which was comparable to the duration of blocks with 0.5% bupivacaine plus epinephrine [ 37 ]. Finally, Sindjelic et al were recently able to show an improvement in quality and duration of mixed bupivacaine/lidocaine cervical plexus blocks for carotid endarterectomy surgery [ 38 ].…”

Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

“…The techniques like paravertebral block, brachial plexus block by infraclavicular approach have been tried for postoperative analgesia following mastectomy. [ 10 11 12 ] Arunakul and Ruksa[ 13 ] found that single injection of paravertebral block (PVB) reduced pain scores and opioid consumption in MRM. However, these techniques are laborious and technically challenging.…”