Effectiveness of Thoracic Paravertebral Block Versus Systemic Opioids for Relief of Postoperative Pain in Patients Undergoing Mastectomy under General Anaesthesia

Sanjiv, L (2013) Effectiveness of Thoracic Paravertebral Block Versus Systemic Opioids for Relief of Postoperative Pain in Patients Undergoing Mastectomy under General Anaesthesia. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

AIM OF THE STUDY: To Study the Effectiveness of Thoracic Paravertebral Block Versus Systemic Opioids for Relief of Post Operative Pain in Patients Undergoing Mastectomy Under General Anaesthesia. BACKGROUND: The incidence of acute postoperative pain in patients undergoing surgery for breast cancer is approximately forty percent. The conventional anaesthetic technique for management of a breast lump has been general anaesthesia and post operative pain relief by opioids. However, the incidence of side effects such as postoperative nausea and vomiting, pain are unacceptably high. To circumvent this problem a number of alternatives were tried. A very successful one among them is the thoracic paravertebral block. It is also considered technically simple and equally efficacious in relieving post operative pain when compared to epidural blocks with lesser incidence of side effects. MATERIALS AND METHODS: We performed this study after getting institutional ethical committee approval (Government Kilpauk Medical College). This study was performed in adult women aged 18-60 years with Body mass index from 18.8 -24.0 belonging to American Society of Anaesthesiologists ASA 1and2 undergoing elective modified radical mastectomy under general anaesthesia. Group A: Twenty five patients receiving standardized general anaesthesia for surgery with thoracic paravertebral block (0.3 ml / kg or 1.5 mg / kg of 0.25%. Bupivacaine at levels T3 and T5) for postoperative pain relief. Group B: Twenty five patients receiving standardized general anesthesia for surgery with systemic opioids. All patients received injection tramadol 100 mg intravenously for post operative pain relief. Post operatively the following parameters were noted and taken for statistical analysis, time duration of complete analgesia, duration of effective analgesia, hemodynamic stability, PONV incidence, sedation , type of rescue analgesia and time, incidence of pneumothorax by checking air entry/X-RAY. RESULTS: The mean duration of complete analgesia (VAS score of zero) in Group A (Study Group)is 70 minutes and in group B (Control Group) is 35.5 minutes which is statistically significant. Hence the time duration of complete analgesia is significantly higher in the thoracic paravertebral block patients. The mean time duration of effective analgesia (VAS<4) in Group A (Study Group) is 308.71 minutes and in Group B (Control Group) is 144.26 minutes which is statistically significant. Hence, the time duration of effective analgesia is significantly higher in thoracic paravertebral block Group (Group A). The need for rescue analgesia in Group A (Study Group) is nil, while in Group B (Control Group) seven out of twenty five patients required rescue analgesia. The incidence of PONV in Group A (Study Group) is nil, while in Group B (Control Group), ten out of twenty five patients reported PONV. Hence, the incidence of PONV is significantly lower in thoracic paravertebral block group. CONCLUSION: This study concludes that thoracic paravertebral block provides a better postoperative analgesia,stable hemodynamic status,,nil incidence of postoperative nausea and vomiting, and overall better comfort for the patients undergoing mastectomy under general anaesthesia than systemic opioids.(injection tramadol).

Item Type: Thesis (Masters)
Uncontrolled Keywords: Effectiveness ; Thoracic Paravertebral Block ; Systemic Opioids ; Relief ; Postoperative Pain ; Patients ; Undergoing Mastectomy ; General Anaesthesia.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 01 May 2018 02:16
Last Modified: 01 May 2018 02:16
URI: http://repository-tnmgrmu.ac.in/id/eprint/7392

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