Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery: a randomized trial
Eficácia do bloqueio do plano serrátil anterior versus bloqueio paravertebral torácico para analgesia pós-operatória após cirurgia de câncer de mama: um estudo randomizado
Suman Arora, Ronithung Ovung, Neerja Bharti, Sandhya Yaddanapudi, Gurpreet Singh
Abstract
Background
Breast cancer surgery is associated with considerable acute post-surgical pain and restricted mobility. Various regional and neuraxial anesthesia techniques have been used to alleviate post-mastectomy pain. Ultrasound-guided serratus anterior plane block (SAPB) has been considered a simple and safe technique. This randomized control study was performed to compare the efficacy of SAPB with the thoracic paravertebral block (TPVB) for postoperative analgesia after breast cancer surgery.
Methods
A total of 40 adults ASA (American Society of Anesthesiologists) physical status III female patients undergoing radical mastectomy were randomly allocated into two groups to receive either ultrasound-guided TPVB or SAPB with 0.4 mL.kg-1 0.5% ropivacaine, 30 min before surgery. All patients received standardized general anesthesia for surgery. Injection diclofenac and tramadol were used for postoperative rescue analgesia. The time to first rescue analgesia, total analgesic consumption in the first 24 hours, postoperative pain scores, and any adverse effects were recorded.
Results
The time to first rescue analgesia was significantly longer in the SAPB group (255.3 ± 47.8 min) as compared with the TPVB group (146.8 ± 30.4 min) (p < 0.001). Total diclofenac consumption in 24 hours was also less in the SAPB group (138.8 ± 44.0 mg vs 210.0 ± 39.2 mg in SAPB and TPVB group respectively, p < 0.001). Postoperative pain scores were significantly lower in the SAPB group as compared with TPVB group (p < 0.05). The incidence of PONV was also less in the SAPB group (p = 0.028). No block-related adverse effects were reported.
Conclusion
We found that the serratus anterior plane block was more effective than the thoracic paravertebral block for postoperative analgesia after breast cancer surgery.
Keywords
Resumo
Introdução: A cirurgia de câncer de mama está associada a dor pós-cirúrgica aguda considerável e mobilidade restrita. Várias técnicas de anestesia regional e neuroaxial têm sido usadas para aliviar a dor pós-mastectomia. O bloqueio do plano anterior do serrátil guiado por ultrassom (BPAS) tem sido considerado uma técnica simples e segura. Este estudo de controle randomizado foi realizado para comparar a eficácia do SAPB com o bloqueio paravertebral torácico (BPVT) para analgesia pós-operatória após cirurgia de câncer de mama. Métodos: Um total de 40 pacientes adultas ASA (American Society of Anesthesiologists) estado físico III submetidas a mastectomia radical foram aleatoriamente alocadas em dois grupos para receber BPVT ou BPAS guiado por ultrassom com 0,4 mL.kg-1 de ropivacaína a 0,5%, 30 min. antes da cirurgia. Todas as pacientes receberam anestesia geral padronizada para cirurgia. Injeção de diclofenaco e tramadol foram usados para analgesia de resgate pós-operatório. O tempo para a primeira analgesia de resgate, o consumo total de analgésico nas primeiras 24 horas, os escores de dor pós-operatória e quaisquer efeitos adversos foram registrados. Resultados: O tempo para a primeira analgesia de resgate foi significativamente maior no grupo BPAS (255,3 ± 47,8 min) em comparação com o grupo BPVT (146,8 ± 30,4 min) (p < 0,001). O consumo total de diclofenaco em 24 horas também foi menor no grupo BPAS (138,8 ± 44,0 mg vs 210,0 ± 39,2 mg no grupo BPAS e BPVT, respectivamente, p < 0,001). Os escores de dor pós-operatória foram significativamente menores no grupo BPAS em comparação com o grupo BPVT (p < 0,05). A incidência de NVPO também foi menor no grupo BPAS (p = 0,028). Nenhum efeito adverso relacionado ao bloqueio foi relatado. Conclusão: Verificamos que o bloqueio do plano serrátil anterior foi mais eficaz que o bloqueio paravertebral torácico para analgesia pós-operatória de cirurgia de câncer de mama.
Palavras-chave
References
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