The analgesic efficacy of a single injection of ultrasound-guided retrolaminar paravertebral block for breast surgery: a prospective, randomized, double-blinded study

Abstract

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

Safety and Efficacy of Ultrasound-Guided Retrolaminar Block of Multiple Injections in Retroperitoneal Laparoscopic Nephrectomy: A Prospective Randomized Controlled Study

“…It was reported that the intraoperative use of remifentanil in breast surgery was higher in patients receiving retrolaminar injection with saline than that in patients receiving RLB with local anesthetic mixture. 25 In our study, we also found that RLB clearly reduced the perioperative consumption of remifentanil, which led to shorter retention time in the recovery room of patients in the RLB group. However, the difference in the cumulative amount of sufentanil, cumulative PAIC bolus at 24 and 48 hours, and the frequency of using remedial drugs might be the reason for which the proportion of PONV in patients in the RLB group was lower than that in patients in the LIA group.…”

Efficacy of superficial cervical plexus block versus cervical retrolaminar block both combined with auriculotemporal nerve block in parotid surgeries

“…In a study involving breast surgery, RLB at T4 showed first analgesic request was at 4.8 (3.0–24) h when using 20 ml of a 0.375% levobupivacaine [ 6 ]. Another study in breast surgery using 20 ml of 0.5% ropivacaine at T7 reported duration of analgesia of up to 12 h, lower VAS from 4 to 12 h [ 7 ]. Different surgeries, levels of injection and no additives explained the different analgesic durations.…”

“…The use of ultrasound, reduces the risk of complications [ 5 ]. Until now, there have been insufficient studies on cervical RLB as an analgesic technique for neck surgeries, through it has been shown to provide effective analgesia in breast surgeries [ 6 , 7 ], rib fractures [ 8 ], and abdominal surgeries, such as retroperitoneal nephrectomy [ 9 ].…”

Retrolaminar versus epidural block for postoperative analgesia after minor video-assisted thoracic surgery: a retrospective, matched, non-inferiority study

“…Although RLB can be performed without ultrasonography, ultrasound images allow for visualization of the needle, catheter and local anesthetic distribution. Some studies reported the application of RLB for chest wall surgery (16)(17)(18)(19).…”