A randomized Controlled Study of the Effects of Single or Multilevel Paravertebral Block on Postoperative Analgesia in Partial Mastectomy with Lymph Node Dissection. | [Anaesthesia, Pain and Intensive Care • 2015]

Author(s):

1. Tomoki Nishiyama: Department of Anesthesiology, Shinagawa Shishokai Hospital, Tokyo, Japan

Abstract:

Objective: Postoperative analgesic effects of paravertebral block in mastectomy is still controversial. The purpose of the present study was to investigate the effectiveness of paravertebral block when given in addition to general anesthesia (GA), and whether a larger single dose or multilevel injections at successive levels are more useful for postoperative analgesia in mastectomy with lymph node dissection. Methodology: This randomized controlled non-blind study was undertken at operating rooms and the indoor facilities at our university hospital. Sixty female patients aged 40 to 65 years, ASA physical status I and II, for partial mastectomy with axillary lymph node dissection were included in the study after ethical committee approval. The patients were divided into three groups; control, single or multilevel block groups. Before GA, in the single block group, paravertebral block using 0.5% ropivacaine 15 ml was performed at T4 level, and in the multilevel group, paravertebral block was performed at T3, 4, and 5 levels with 0.5% ropivacaine 5 ml each. In the control group, no block was performed. GA was induced with midazolam, fentanyl, propofol, and vecuronium. Laryngeal mask airway #3 was inserted. Anesthesia was maintained with propofol infusion and intermittent fentanyl as necessary under 50% nitrous oxide in oxygen (total flow 4 L/min). For postoperative analgesia, pentazocine 15 mg was administered intramuscularly as patients' request. Measurements: The dose of fentanyl used during surgery, frequency of pentazocine request in postoperative 24 hours, time to the first pentazocine administration, and postoperative pain measured by visual analogue scale (VAS, 0 to10) for 24 hours were compared among the groups. Results: Dose of fentanyl during surgery was significantly larger in the control group than the single and multilevel groups. Frequency of postoperative pentazocine administration was significantly larger in the control group than the single and multilevel groups. There were no differences in the dose of fentanyl and frequency of pentazocine administration between the single and multilevel groups. Conclusion. Single large dose paravertebral block at T4 is equally useful for postoperative analgesia in mastectomy with lymph nodes dissection when compared to multilevel blocks at T3 to T5.

Page(s): 463-467

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 19, Issue: 4, Year: 2015

Keywords:

Keywords are not available for this article.

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