Can combined paravertebral and erector spinae block provide perioperative analgesia for mastectomy with LD flap reconstruction surgery? An observational study.

IF 1.2 Q4 ONCOLOGY
ecancermedicalscience Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI:10.3332/ecancer.2024.1781
Arunangshu Chakraborty, Sanjit Agrawal, Shiladitya Bose, Rosina Ahmed, Rakhi Khemka
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Abstract

Background: Mastectomy and breast reconstruction with latissimus dorsi myocutaneous flap (LDF) is a major surgery that covers eight or more dermatomes causing severe pain in the postoperative period.

Objectives: We evaluated the analgesic effect of a hybrid technique of ultrasound-guided combined thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in a single needle pass in ten consecutive patients scheduled for mastectomy with LDF reconstruction as a part of a multimodal analgesia regimen.

Design: Prospective observational study.

Setting: A tertiary-level cancer hospital in Eastern India. The study was conducted between 01/09/2023 and 20/12/2023.

Patients: 10 consecutive consenting female patients of age between 18 and 75 years suffering from breast cancer, scheduled for a mastectomy with LDF reconstruction were recruited in this study, excluding patients with body mass index more than 40, coagulopathy or thrombocytopenia, skin conditions such as dermatitis, infection and so on, and known allergy to local anaesthetics (LAs).

Interventions: The recruited patients received an ultrasound-guided combined thoracic paravertebral and erector spinae (COMPARES) block at the third thoracic (T3) level in a single needle pass, with 10 mL in the TPVB and 30 mL in the ESPB compartment, respectively, in a cephalad to caudad approach before induction of general anaesthesia.

Main outcome measures: The primary endpoint was pain score at 9:00 am on postoperative day one. Other outcome measures were pain scores at postoperative hours 0 (immediately after awakening from general anaesthesia), 4, 8 and 12, postoperative nausea vomiting, requirement of rescue analgesics and pain score on shoulder movements on postoperative day one.

Results: Median (range) resting pain scores at 0, 4, 8 and 24 hours were 1.5 (0-5), 2.5 (0-4), 2.5 (2-5) and 3 (2-4), and dynamic pain score on shoulder mobilization on postoperative day one morning was 3 (2-6). Only one patient required rescue analgesia.

Conclusions: We found the technique inexpensive and potentially useful, but difficult in obese and short-statured patients due to increased depth and narrowing of the intertransverse space. This technique should be further evaluated in a randomised controlled trial.

Trial registration: This trial was registered with the Clinical Trials Registry of India with the registration number CTRI/2023/08/057119.

椎旁和竖脊肌联合阻滞能否为乳房切除LD皮瓣重建手术提供围手术期镇痛?一项观察性研究。
背景:背阔肌肌皮瓣(LDF)乳房切除术和乳房重建术是一项涉及八个或更多皮节的大手术,会导致术后剧烈疼痛:我们评估了超声引导下胸椎旁联合阻滞(TPVB)和竖脊肌平面阻滞(ESPB)混合技术的镇痛效果:前瞻性观察研究:地点: 印度东部一家三级癌症医院。研究时间:2023 年 9 月 1 日至 2023 年 12 月 20 日:本研究连续招募了 10 名年龄在 18 岁至 75 岁之间、计划接受乳房切除术并进行 LDF 重建的女性乳腺癌患者,排除了体重指数超过 40、患有凝血功能障碍或血小板减少症、患有皮炎、感染等皮肤疾病以及已知对局麻药(LAs)过敏的患者:入组患者在诱导全身麻醉前,在超声引导下,在第三胸椎(T3)水平进行胸椎椎旁和竖脊肌(COMPARES)联合阻滞,单次进针,分别在TPVB和ESPB腔内注入10毫升和30毫升:主要终点是术后第一天上午 9:00 的疼痛评分。其他结果测量指标包括术后第0、4、8和12小时的疼痛评分、术后恶心呕吐、镇痛药需求量和术后第一天肩部活动时的疼痛评分:结果:术后 0、4、8 和 24 小时的静息疼痛评分中位数(范围)分别为 1.5(0-5)、2.5(0-4)、2.5(2-5)和 3(2-4),术后第一天早上肩部活动时的动态疼痛评分为 3(2-6)。只有一名患者需要镇痛抢救:我们发现该技术成本低廉且具有潜在的实用性,但对于肥胖和身材矮小的患者来说,由于横向间隙的深度和狭窄程度增加,该技术难以实施。这项技术应在随机对照试验中进一步评估:该试验已在印度临床试验登记处登记,登记号为CTRI/2023/08/057119。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
5.60%
发文量
138
审稿时长
27 weeks
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