The analgesic efficacy of a single injection of ultrasound-guided retrolaminar paravertebral block for breast surgery: a prospective, randomized, double-blinded study
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (30)
- Harris E, "Meta-analysis to determine if surgical resection of the primary tumour in the setting of stage IV breast cancer impacts on survival", Ann Surg Oncol, 20, pp.2828~2834 (2013)
- Alves Nogueira Fabro E, "Post-mastectomy pain syndrome: incidence and risks", Breast, 21, pp.321~325 (2012)
- Chiu C, "Improved analgesia and reduced postoperative nausea and vomiting after implementation of an enhanced recovery after surgery(ERAS)pathway for total mastectomy", BMC Anesthesiol, 18, pp.41~ (2018)
- Hickey OT, "Severity of acute pain after breast surgery is associated with the likelihood of subsequently developing persistent pain", Clin J Pain, 26, pp.556~560 (2010)
- Terkawi AS, "Improving analgesic efficacy and safety of thoracic paravertebral block for breast surgery : a mixedeffects meta-analysis", Pain Physician, 18, pp.E757~80 (2015)
- Karmakar MK, "Thoracic paravertebral block", Anesthesiology, 95, pp.771~780 (2001)
- Pace MM, "Ultrasound-guided thoracic paravertebral blockade : a retrospective study of the incidence of complications", Anesth Analg, 122, pp.1186~1191 (2016)
- Albi-Feldzer A, "A severe complication after ultrasound-guided thoracic paravertebral block for breast cancer surgery : total spinal anaesthesia : a case report", Eur J Anaesthesiol, 33, pp.949~951 (2016)
- Kus A, "Pleural puncture and intrathoracic catheter placement during ultrasound guided paravertebral block", J Cardiothorac Vasc Anesth, 27, pp.e11~2 (2013)
- Pfeiffer G, "Analgesia of the axilla using a paravertebral catheter in the lamina technique", Anaesthesist, 55, pp.423~427 (2006)
- Voscopoulos C, "The ultrasound-guided retrolaminar block", Can J Anaesth, 60, pp.888~895 (2013)
- Zeballos JL, "Ultrasound-guided retrolaminar paravertebral block", Anaesthesia, 68, pp.649~651 (2013)
- Murouchi T, "Retrolaminar block : analgesic efficacy and safety evaluation", J Anesth, 30, pp.1003~1007 (2016)
- Onishi E, "Analgesic effect of double-level retrolaminar paravertebral block for breast cancer surgery in the early postoperative period : a placebo-controlled, randomized clinical trial", Tohoku J Exp Med, 245, pp.179~185 (2018)
- Piacherski Valery, "A comparison of the onset time of complete blockade of the sciatic nerve in the application of ropivacaine and its equal volumes mixture with lidocaine: a double-blind randomized study", Korean Journal of Anesthesiology, 65(1), pp.42~47 (2013), 대한마취통증의학회
- Rohan B, "Addition of clonidine or lignocaine to ropivacaine for supraclavicular brachial plexus block : a comparative study", Singapore Med J, 55, pp.229~232 (2014)
- Das S, "Multiple-injection thoracic paravertebral block as an alternative to general anaesthesia for elective breast surgeries : a randomised controlled trial", Indian J Anaesth, 56, pp.27~33 (2012)
- Agarwal RR, "Single-injection thoracic paravertebral block and postoperative analgesia after mastectomy : a retrospective cohort study", J Clin Anesth, 27, pp.371~374 (2015)
- Kairaluoma PM, "Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy", Anesth Analg, 99, pp.1837~1843 (2004)
- Kaya FN, "Thoracic paravertebral block for video-assisted thoracoscopic surgery : single injection versus multiple injections", J Cardiothorac Vasc Anesth, 26, pp.90~94 (2012)
- Naja ZM, "Thoracic paravertebral block : influence of the number of injections", Reg Anesth Pain Med, 31, pp.196~201 (2006)
- Onishi E, "Comparison of clinical efficacy and anatomical investigation between retrolaminar block and erector spinae plane block", Biomed Res Int, 2019, pp.2578396~ (2019)
- Costache I, "Does paravertebral block require access to the paravertebral space?", Anaesthesia, 71, pp.858~859 (2016)
- Adhikary SD, "Erector spinae plane block versus retrolaminar block : a magnetic resonance imaging and anatomical study", Reg Anesth Pain Med, 43, pp.756~762 (2018)
- Sabouri AS, "Is a retrolaminar approach to the thoracic paravertebral space possible? : a human cadaveric study", Reg Anesth Pain Med, 43, pp.864~868 (2018)
- Damjanovska M, "The ultrasound-guided retrolaminar block : volume-dependent injectate distribution", J Pain Res, 11, pp.293~299 (2018)
- Yang HM, "Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region : a cadaveric study", Anaesthesia, 73, pp.1244~1250 (2018)
- Simpson D, "Ropivacaine : a review of its use in regional anaesthesia and acute pain management", Drugs, 65, pp.2675~2717 (2005)
- Boohwi Hong, "Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study", The Korean Journal of Pain, 32(3), pp.206~214 (2019), 대한통증학회[DOI]
- Eric S. Schwenk, "Designing the ideal perioperative pain management plan starts with multimodal analgesia", Korean Journal of Anesthesiology, 71(5), pp.345~352 (2018), 대한마취통증의학회