EVALUATION OF ULTRASOUND GUIDED THORACIC PARAVERTEBRAL BLOCK IN PERIOPERATIVE PAIN MANAGEMENT IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY
Galal Abo El Seoud Saleh*, Mohamed Saleh Ahmed*, Rania Hassan Abdel Hafiez* & Mina Nabil Habib Mikhail
*Department of Anesthesiology, Intensive care and pain management, Faculty of Medicine-Ain Shams University
Background: Thoracic paravertebral block (TPVB) is an effective intraoperative and technique for surgical anaesthesia and analgesia for breast surgery. It offers a long-lasting effective analgesia without increases in side effects, with a significant decrease in anaesthetic and analgesic consumption, and with a high degree of patient satisfaction and shorter recovery time. Paravertebral blockade (PVB) is a regional anaesthetic technique with a large number of indications. PVB is usually performed with landmark-based techniques, methods that rely on pressure differences between the extra- and intra paravertebral space or ultrasound guided. Aims: The aim of this study is to evaluate the efficacy of US guided paravertebral block compared to systemic opioid, Identify the effect of US-guided paravertebral block on analgesic requirement needed to control post-operative pain and shorten the length of hospital stay and to assess surgeon and patient satisfaction. Methodology: In the current study, the analgesic efficacy of thoracic paravertebral block in comparison to the IV opioids in breast surgery was evaluated .The two study groups were: Group A: (n=20) received general anaethesia in addition to thoracic paravertebral block was performed by ultrasound using bupivacaine. Group B: (n=20) received general anaethesia alone. Forty female patients were enrolled in this study in Nasser Institute for Research and Treatment, Cairo, Egypt. The patients’ age range from 18-60 years and they were randomly allocated by a computer-generated table into one of the 2 study groups. They were all scheduled to undergo elective breast surgery (modified radical mastectomy).the two groups received general anaesthesia. The TPV block was performed in group A after induction of anaethesia and before surgical incision, using ultrasound machine Logic model from GE (General electric company). Results: the study there was a statistical difference in fentanyl consumption intraoperatively between control group and TPV block group. The mean fentanyl consumption was 142.00 μg in the paravertebral group while was 231.00 μg in the control group (p<0.05). In this study, Mean morphine consumption in paravertebral group was 3.632 ± 1.257mg in group-A (control group) versus 0.75 ± 1.916mg in group-B (study group) in first 24 hours postoperatively (p<0.05). These results are consistent with other previous studies. Conclusion: This study demonstrates that real time ultrasound guided TPVB proved to be a simple and safe procedure in providing effective reliable analgesia, together with reduction of postoperative pain scores and postoperative opioid requirements together with their systemic side effects.