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Ultrasound Guided Paravertebral Block in Modified Radical Mastectomy Procedures

Year 2020, Volume: 42 Issue: 2, 155 - 159, 17.03.2020

Abstract

Total paravertebral block is a common analgesic and anesthetic technique
that used in mastectomy procedures. In this study we aim to show the effects of
ultrasound guided paravertebral block administiration on introperative opioid
consumption and postoperative pain in modified radical mastectomy procedures. Nineteen
patients that underwent thoracal paravertebral block with a diagnosis of
modified radical mastectomy between 2017-2018 years were analysed
retrospectively. Demographical parameters, procedure duration, intraoperative
and postoperative 24 hours analgesic consumption were analysed. Statistical
evaluation were performed with SPSS for Windows 21.0 programme. P<0.05 value
was identified as statistical significance. Patients ages were between the
range of 20-79 years and age avarage was 50,89 (±15,74). Three patients were
ASA I, 6 patients were ASA II and 10 patients were ASA III. Body Mass Index
avarage was 29,92(±3,99). Procedure duration avarage was 129,05(±66,04) minutes.
Patients were divided into two goups; Group 1 (n=10): TPVB was not applied,
Group 2 (n=9): TPVB was applied. There were no significant difference between
groups in means of age and procedure duration. All patients in group 1 required
opioid medication. Two patients required remifentanyl infusion, 4 patients
required 100 µg and 4 patients required 150 µg intravenous fentanyl. None of
the patients in Group 2 required opioid medication and this condition found
statistically significant (p<0.005). All patients in Group 1 required
postoperative analgesic treatment. Five patients had given contramal 60 µg 3*1,
5 patients had given contramal 60 µg 4*1. There were no postoperative analgesic
requirement in Group 2 and it was statistically significant (p<0.005). Ultrasound guided thoracal
paravertebral block in modified radical mastectomy provides an opioid free
intraoperative period and obtain analgesia for postoperative 24 hours.

References

  • Referans 1. Megha T, Hegde HV, Rao PR. Paravertebral block with morphine or dexmedetomidine as adjuvant to bupivacaine for post-operative analgesia in modified radical mastectomy: A prospective, randomised, double-blind study. Indian J Anaesth. 2018;62:424-430.
  • Referans 2. Yılmaz Ö, Saraçoğlu A, Bezen O, Şengül T. Modifiye radikal mastektomi uygulanan hastalarda torakal paravertebral blok uygulamasının ameliyat sonrası analjezi üzerine etkileri. Ağrı 2014;26(4):179-183.
  • Referans 3. Naja Z, Lönnqvist PA. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia 2001;56(12):1184-1188.
  • Referans 4. Beyaz GS, Ergönenç T, Altıntoprak F. Epidural spread developed after thoracic paravertebral block in breast cancer surgery: A case report. Kocatepe Medical Journal 2013;14(3):150-153.
  • Referans 5. Rukewe A, Afuwape OO, Ugheoke A, Fatiregun AA. Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy. Local Reg Anesth. 2016;6(9):83-86.
  • Referans 6. Sahu A, Kumar R, Hussain M, Gupta A, Raghwendra KH. Comparisons of single-injection thoracic paravertebral block with ropivacaine and bupivacaine in breast cancer surgery: A prospective, randomized, double-blinded study. Anesth Essays Res. 2016;10(3):655-660.
  • Referans 7. Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single-injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand. 1999;43(7):770-774.
  • Referans 8. Arunakul P, Ruksa A. General anesthesia with thoracic paravertebral block for modified radical mastectomy. J Med Assoc Thai. 2010;93(7):149-153.
  • Referans 9. Sidiropoulou T1, Buonomo O, Fabbi E et al. A prospective comparison of continuous wound infiltration with ropivacaine versus single-injection paravertebral block after modified radical mastectomy. Anesth Analg. 2008;106(3):997-1001.

Modifiye Radikal Mastektomi Operasyonlarında Ultrason Eşliğinde Paravertebral Blok Uygulamalarımız

Year 2020, Volume: 42 Issue: 2, 155 - 159, 17.03.2020

Abstract

Torakal
paravertebral blok meme cerrahisinde etkili bir anestezi ve analjezi
yöntemidir. Çalışmadaki amacımız modifiye radikal mastektomi operasyonlarında
ultrason eşliğinde yapılan torakal paravertebral bloğun intraoperatif opioid
ihtiyacını ve postoperatif analjezi gereksinimini azalttığını göstermektir. Çalışmamıza
2017-2018 yılları arasında modifiye radikal mastektomi tanısı ile torakal
paravertebral blok yapılan 19 hasta retrospektif incelenerek dahil edildi.
Hastaların demografik verileri, operasyon süreleri ve intraoperatif opioid ve
postoperatif ilk 24 saat analjezik gereksinimleri değerlendirildi.
İstatistiksel değerlendirme SPSS for Windows 21.0 programı ile yapıldı.
p<0.05 değeri istatistiksel olarak anlamlı kabul edildi. 20-79 yaş
aralığında olan hastaların yaş ortalaması 50,89 (±15,74) idi. 3 hasta  ASA I, 6 hasta ASA II ve 10 hasta ASA III
idi. Vücut kitle indeksi ortalama 29,92(±3,99) idi. Operasyon süresi ortalama
129,05(±66,04) dakika idi. Hastalar TPVB yapılmayan:Grup 1 (n:10) ve TPVB
yapılan:Grup 2 (n:9): olarak 2 gruba ayrıldı. Gruplar arasında hastaların yaş
ortalaması ve operasyon süreleri açısından fark yoktu. Grup 1’deki tüm
hastaların  opioid ihtiyacı oldu. 2
hastada Remifentanil infüzyonu, 4 hastada Fentanil 100 mg ve 4 hastada ise 150
mg Fentanil ihtiyacı oldu. Grup 2’de ise hiç opioid ihtiyacı olmadı. Bu durum
istatistiki olarak da anlamlıydı (p<0.005). Postoperatif dönemde Grup 1’deki
hastaların tümünün analjezik gereksinimi oldu. 5 hastanın Contramal 60 mg 3*1,
5 hastanın  da Contramal 60 mg 4*1
ihtiyacı oldu. Grup 2’deki hastalarda hiç analjezik ihtiyacı olmadı.  Bu durum istatistiki olarak da anlamlı idi
(p<0.005). Modifiye radikal mastektomi olgularında ultrasonografi eşliğinde
yapılan torakal paravertebral blok ile intraoperatif dönemde opioid gereksinimi
olmazken postoperatif ilk 24 saate analjeziğe ihtiyaç olmamaktadır.

References

  • Referans 1. Megha T, Hegde HV, Rao PR. Paravertebral block with morphine or dexmedetomidine as adjuvant to bupivacaine for post-operative analgesia in modified radical mastectomy: A prospective, randomised, double-blind study. Indian J Anaesth. 2018;62:424-430.
  • Referans 2. Yılmaz Ö, Saraçoğlu A, Bezen O, Şengül T. Modifiye radikal mastektomi uygulanan hastalarda torakal paravertebral blok uygulamasının ameliyat sonrası analjezi üzerine etkileri. Ağrı 2014;26(4):179-183.
  • Referans 3. Naja Z, Lönnqvist PA. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia 2001;56(12):1184-1188.
  • Referans 4. Beyaz GS, Ergönenç T, Altıntoprak F. Epidural spread developed after thoracic paravertebral block in breast cancer surgery: A case report. Kocatepe Medical Journal 2013;14(3):150-153.
  • Referans 5. Rukewe A, Afuwape OO, Ugheoke A, Fatiregun AA. Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy. Local Reg Anesth. 2016;6(9):83-86.
  • Referans 6. Sahu A, Kumar R, Hussain M, Gupta A, Raghwendra KH. Comparisons of single-injection thoracic paravertebral block with ropivacaine and bupivacaine in breast cancer surgery: A prospective, randomized, double-blinded study. Anesth Essays Res. 2016;10(3):655-660.
  • Referans 7. Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single-injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand. 1999;43(7):770-774.
  • Referans 8. Arunakul P, Ruksa A. General anesthesia with thoracic paravertebral block for modified radical mastectomy. J Med Assoc Thai. 2010;93(7):149-153.
  • Referans 9. Sidiropoulou T1, Buonomo O, Fabbi E et al. A prospective comparison of continuous wound infiltration with ropivacaine versus single-injection paravertebral block after modified radical mastectomy. Anesth Analg. 2008;106(3):997-1001.
There are 9 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section ORİJİNAL MAKALE
Authors

Gülçin Aydın 0000-0001-9672-7666

Oktay Aydın 0000-0001-5728-0128

İşın Gençay 0000-0001-5279-9975

Faruk Pehlivanlı 0000-0002-2175-8756

Selim Çolak 0000-0002-8364-982X

Çağatay Daphan 0000-0003-2887-3332

Kuzey Aydınuraz This is me 0000-0003-3345-233X

Gökhan Karaca This is me 0000-0002-5107-5999

Ünase Büyükkoçak This is me 0000-0001-8472-6041

Publication Date March 17, 2020
Published in Issue Year 2020 Volume: 42 Issue: 2

Cite

Vancouver Aydın G, Aydın O, Gençay İ, Pehlivanlı F, Çolak S, Daphan Ç, Aydınuraz K, Karaca G, Büyükkoçak Ü. Modifiye Radikal Mastektomi Operasyonlarında Ultrason Eşliğinde Paravertebral Blok Uygulamalarımız. Osmangazi Tıp Dergisi. 2020;42(2):155-9.


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