Title: Single injection thoracic paravertebral block for mastectomy operation: a comparative study between ropivacaine and bupivacaine

Authors: Dr Neetika Mishra M.D., Dr Santanu Ghosh M.D., Dr Samit Kumar Khutia M.D., Dr Richeek Kumar Pal M.D., Dr Ahito Kibami M.B.B.S.

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.144

Abstract

In recent years, regional anaesthetic techniques are being preferred as an adjuvant to general anaesthesia for the relief of postoperative pain. Breast surgeries are widely performed for cosmetic as well as oncological reasons and are associated with severe pain, PONV and respiratory complications due to inadequate pain relief. The present study was carried out to compare the efficacy of bupivacaine and ropivacaine in a single injection paravertebral block for controlling the postoperative pain after an elective breast surgeries.

Method: Seventy-two female patients scheduled for elective breast surgery were randomized into two groups; R (Ropivacaine group) and B (bupivacaine group), 36 patients were allotted to each group. Both the groups received single injection paravertebral block with either of the drug. Surgery was conducted under general anaesthesia in both the groups. Intensity of postoperative pain was measured by VAS score at 2, 4, 6, 9, 12, 18 and 24 hrs. Intensity of pain and the analgesic consumption over the past 24 hours were recorded. Duration of postoperative analgesia was calculated by the time of first analgesic requirement.

Results: VAS scores in the immediate postoperative period that is 2-12 hrs. were comparable between both the groups (p> 0.05), however the VAS score at 9, 18 and 24 hours were significantly higher in group R. Fentanyl consumption in the first 24 hours was 68.06±23.612µg for the group R as compared to 76.39±17.87µg for the group B which is statistically insignificant. The time to request for 1st analgesic was 646.56±115.85min in the group R and 609.25±75.02mins in the group B (p>0.05) which is also statistically insignificant.

Conclusion: Ropivacaine and Bupivacaine both provide good quality of analgesia after single injection thoracic paravertebral block in breast surgeries.

Keywords: Ropivacaine, Bupivacaine, Paravertebral block, postoperative analgesia.

References

  1. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain 2006; 7: 626-34.
  2. Greengrass R, O‘Brien F, Lyerly K, Hardman D, Gleason D, D‘Ercole F, et al. Paravertebral block for breast cancer surgery. Can J Anaesth 1996;43:858–61.
  3. Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N and Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. J Am Med Assoc 2009; 302: 1985-92.
  4. D‘Ercole FJ, Scott D, Bell E, Klein SM, Greengrass RA. Paravertebral blockade for modified radical mastectomy in a pregnant patient. AnesthAnalg 1999; 88:1351–3.
  5. Buckenmaier III CC, Steele SM, Nielsen KC, Klein SM. Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomy-opathy. Can J Anaesth 2002; 49: 571–4.
  6. Buckenmaier III CC, Steele SM, Nielsen KC, Martin AH, Klein SM. Bilateral continuous paravertebral catheters for reduction mammoplasty. Acta AnaesthesiolScand 2002; 46: 1042–5.
  7. Najarian MM, Johnson JM, Landercasper J, Havlik P, Lambert PJ, McCarthy D. Paravertebral block: an alternative to general anesthesia in breast cancer surgery. Am Surg 2003; 69: 213–8.
  8. Hura G, Knapik P, Misiolek H, Krakus A, Kare J, et al. Sensory blockade after thoracic paravertebral injection of ropivacaine or bupivacaine. Eur J Anaesthesiol 2006;23: 658– 64.
  9. Naja MZ, Ziade MF, Lonnqvist PA. Nerve-stimulator guided paravertebral blockade vs. general anaesthesia for breast surgery: a prospective randomized trial. Eur J Anaesthesiol 2003;20:897–903.
  10. 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: 770–4.
  11. Terheggen MA, Wille F, Rinkes IHB, Ionescu TI, Knape JT. Paravertebral blockade for minor breast surgery. AnesthAnalg 2002; 94: 335–9.
  12. Bertini L, Tagariello V, Mancini S et al. 0.75% and 0.5% ropivacaine for axillary brachial plexus block: a clinical comparison with 0.5% bupivacaine. Region Anesth Pain Med 1999; 24: 514–8.
  13. Cheema SP, Ilsley D, Richardson J, Sabanathan S. A thermographic study of paravertebral analgesia. Anaesthesia 1995; 50: 118-21.
  14. Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tayara K, Younes F et al. Thoracic paravertebral block: influence of the number of injections. Reg Anesth Pain Med 2006; 31: 196–201.
  15. Apfelbaum JL, Chen C, Mehta SS and Gan TJ. Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged. AnesthAnalg 2003; 97: 534-40.
  16. McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs 2000; 60: 1065–93.
  17. Richardson J. Paravertebral and intercostal nerve blocks. In: Narrinder R, ed. Highlights in Regional Anaesthesia and Pain Therapy, Vol. X. Limassol, Cyprus: Cyprint Ltd, 2001:113–20.
  18. Wang RD, Dangler LA, Greengrass RA. Update on ropivacaine. Expert OpinPharmacother 2001; 2: 2051–63.
  19. Brown DL, Carpenter RL, Thompson GE. Comparison of 0.5% ropivacaine and 0.5% bupivacaine for epidural anesthesia in patients undergoing lower-extremity surgery. Anesthesiology 1990; 72: 633–6.
  20. Akerman B, Hellberg IB, Trossvik C. Primary evaluation of the local anaesthetic properties of the amino amide agent ropivacaine (LEA 103). Acta Anaesthesiol Scand 1988; 32: 571–8.
  21. Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injectionparavertebral block before general anaesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. AnesthAnalg 2004; 99: 1837– 43.
  22. Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carlsson PS. Thoracic Paravertebral Block for Breast Cancer Surgery: A Randomized Double-Blind Study. AnesthAnalg 2007; 105: 1848 –51.
  23. Coveney E, Weltz CR, Greengrass R, Iglehart JD, Leight GS, Steele SM, et al. Use of paravertebral block anesthesia in the surgical management of breast cancer: Experience in 156 Cases. Ann Surg. 1998;227:496–501.
  24. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. AnesthAnalg 2000; 90: 1402–5.

Corresponding Author

Dr Santanu Ghosh M.D.

Assistant Professor, Dept. of Anesthesiology, North Bengal Medical College, Darjeeling, West Bengal

INDIA