Details
Category: Volume 06 Issue 03 March 2018
Hits: 1340

Title: Thoracic Paravertebral Block, a Suitable and Safe Adjunct for General Anaesthesia, for Post-Operative Pain Relief in Modified Radical Mastectomies

Authors: Gayatri Sasikumar, Rachel C Koshy, Deepthi J Prabhu

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.75

Abstract

Introduction

Paravertebral block (PVB) has  been safely used as a sole anaesthetic or as a supplement to GA in patients undergoing breast surgery.1 It’s analgesic effect is attributed to its distinctive property of  eliminating cortical responses to thoracic dermatomal stimulation.2,3 which clinically translates to prolonged sensory neural block  resulting in decreased analgesic requirements.4 Further  merits of PVB include a reduced incidence of  post operative nausea and vomiting, early  ambulatory discharge & preventive benefit in chronic pain following mastectomy1. Acute post operative pain has been postulated to be an important contributory factor in perioperative immune suppression which has been hypothesized to have a role in tumour progression and recurrence5. PVB due to its superior analgesic efficacy may thus have a beneficial role in contributing to a recurrence free survival in patients with carcinoma breast.

In this study, we aim to show the prolonged post-operative analgesic effect provided by PVB, when used as a supplement to general anaesthesia and the resultant reduction in postoperative opioid and analgesic requirements. Our rationale in using paravertebral block, is its relative ease of performance with lesser incidence of complications & hemodynamic variations.

References

  1. Klein SM, Bergh A, Steel SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. AnesthAnalg 2000;90:1402–5.
  2. Stevenson GW, Hall SC, Rudnick S, Seleny FL, Stevenson HC. The effect of anesthetic agents on the human immune response. Anesthesiology 1990;72:542–52.
  3. Oakley N, Dennison A, Shorthouse A. A prospective audit of simple mastectomy under local anesthesia. Eur J SurgOncol 1996;2:131– 6.
  4. Coveney E, Weltz CR, Greengrass R, et al.Use of paravertebral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Annals of surgery.1998; 227(4): 496-501)
  5. Divatia JV, Ambulkar. Anaesthesia and cancer recurrence:What is the evidence? Journal of Anaesthesiology, Clinical pharmacology.2014;30(2):147-150.
  6. Dabbagh A, Elyasi H. The role of paravertebral block in decreasing post-operative pain in elective breast surgeries. Med SciMonit 2007;13:CR464–7.
  7. El Nasr G, El Moutaz H, Youssef M. Paravertebral block versus general anaesthesia in breast surgery. JESMP 2002;20:125–30.
  8. Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. AnesthAnalg 2004;99:1837–43
  9. 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.
  10. Buckenmaier CC 3 rd , Klein SM, Nielsen KC, Steele SM. Continuous Paravertebral Catheter and Outpatient Infusion for breast surgery. AnaesthAnalg 2003;97:715-7.
  11. Matthews PJ, Govenden V. Comparison of continuous paravertebral and extradural infusions of bupivacaine for pain relief after thoracotomy. Br J Anaesth 1989;62:204-5.
  12. Miguel R, Rothschiller J, Majchrzak J. Breast surgery is a high risk procedure for development of nausea and vomiting. Anesthesiology 1993;79:A1095.
  13. Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single injection Paravertebral block compared to general anaesthesia in breast surgery. ActaAnaesthesiolScand 1999;43:770-4.
  14. Terheggen MK, Wille F, BorelRinkes IH, Ionescu TI, Knape JT. Paravertebral blockade for minor breast surgery. AnesthAnalg 2002;94:355-9.
  15. 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
  16. Hadzic A, Kerimoglu B, Loreio D, Karaca P, Claudio R, Yufa M, Wedderburn R, Santos A, Thys D. Paravertebral blocks provide superior same-day recovery over general anaesthesia for patients undergoing inguinal hernia repair. Anesth Analg 2006;102:1076–81
  17. Thavaneswaran P, Rudkin GE, Cooter RD, Moyes DG, Perera CL, Maddern GJ. Brief reports: paravertebral block for anesthesia: a systematic review. AnesthAnalg. 2010 Jun 1;110(6):1740-4.
  18. Wassef M, Randazzo T, Ward W. The paravertebral nerve root block for inguinal herniorrhaphy—a comparison with the field block approach. RegAnesth Pain Med 1998;23:451–6.
  19. Lönnqvist PA, MacKenzie J, Soni AK, Conacher ID. Paravertebral blockade. Failure rate and complications. Anaesthesia 1995;50:813-5.
  20. Hura G, Knapik P, Misiolek H, Krakus A, Karpe J. Sensory blockade after thoracic paravertebral injection of ropivacaine or bupivacaine. Eur J Anaesthesiol 2006;23:658–64.
  21. Weltz CR, Greengrass RA, Lyerly HK. Ambulatory surgical management of breast carcinoma using paravertebral block. Ann Surg 1995;222:19–26.
  22. 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
  23. Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tayara K, Younes F, Lonnqvist PA. Thoracic paravertebral block: influence of the number of injections. Reg Anesth Pain Med 2006;31:196–201.

Corresponding Author

Dr Deepthi. J Prabhu

Assistant Professor, Division of Anaesthesiology,

Regional Cancer Centre, Trivandrum

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob: 9895006045