The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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The analgesic efficacy of a single injection of ultrasound-guided retrolaminar paravertebral block for breast surgery: a prospective, randomized, double-blinded study

  • Hwang, Boo-Young (Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine) ;
  • Kim, Eunsoo (Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine) ;
  • Kwon, Jae-young (Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine) ;
  • Lee, Ji-youn (Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine) ;
  • Lee, Dowon (Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine) ;
  • Park, Eun Ji (Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine) ;
  • Kang, Taewoo (Department of Busan Cancer Center (Breast Cancer Clinic), Pusan National University Hospital)
  • Received : 2020.02.20
  • Accepted : 2020.07.14
  • Published : 2020.09.30
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Abstract

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

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References

  1. Harris E, Barry M, Kell MR. Meta-analysis to determine if surgical resection of the primary tumour in the setting of stage IV breast cancer impacts on survival. Ann Surg Oncol 2013; 20: 2828-34. https://doi.org/10.1245/s10434-013-2998-2
  2. Alves Nogueira Fabro E, Bergmann A, do Amaral E Silva B, Padula Ribeiro AC, de Souza Abrahao K, da Costa Leite Ferreira MG, et al. Post-mastectomy pain syndrome: incidence and risks. Breast 2012; 21: 321-5. https://doi.org/10.1016/j.breast.2012.01.019
  3. Chiu C, Aleshi P, Esserman LJ, Inglis-Arkell C, Yap E, Whitlock EL, et al. Improved analgesia and reduced postoperative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) pathway for total mastectomy. BMC Anesthesiol 2018; 18: 41. https://doi.org/10.1186/s12871-018-0505-9
  4. Hickey OT, Burke SM, Hafeez P, Mudrakouski AL, Hayes ID, Shorten GD. Severity of acute pain after breast surgery is associated with the likelihood of subsequently developing persistent pain. Clin J Pain 2010; 26: 556-60. https://doi.org/10.1097/AJP.0b013e3181dee988
  5. Terkawi AS, Tsang S, Sessler DI, Terkawi RS, Nunemaker MS, Durieux ME, et al. Improving analgesic efficacy and safety of thoracic paravertebral block for breast surgery: a mixedeffects meta-analysis. Pain Physician 2015; 18: E757-80.
  6. Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001; 95: 771-80. https://doi.org/10.1097/00000542-200109000-00033
  7. Pace MM, Sharma B, Anderson-Dam J, Fleischmann K, Warren L, Stefanovich P. Ultrasound-guided thoracic paravertebral blockade: a retrospective study of the incidence of complications. Anesth Analg 2016; 122: 1186-91. https://doi.org/10.1213/ANE.0000000000001117
  8. Albi-Feldzer A, Duceau B, Nguessom W, Jayr C. A severe complication after ultrasound-guided thoracic paravertebral block for breast cancer surgery: total spinal anaesthesia: a case report. Eur J Anaesthesiol 2016; 33: 949-51. https://doi.org/10.1097/EJA.0000000000000536
  9. Kus A, Gurkan Y, Gul Akgul A, Solak M, Toker K. Pleural puncture and intrathoracic catheter placement during ultrasound guided paravertebral block. J Cardiothorac Vasc Anesth 2013; 27: e11-2. https://doi.org/10.1053/j.jvca.2012.10.018
  10. Pfeiffer G, Oppitz N, Schone S, Richter-Heine I, Hohne M, Koltermann C. Analgesia of the axilla using a paravertebral catheter in the lamina technique. Anaesthesist 2006; 55: 423-7. https://doi.org/10.1007/s00101-005-0969-0
  11. Voscopoulos C, Palaniappan D, Zeballos J, Ko H, Janfaza D, Vlassakov K. The ultrasound-guided retrolaminar block. Can J Anaesth 2013; 60: 888-95. https://doi.org/10.1007/s12630-013-9983-x
  12. Zeballos JL, Voscopoulos C, Kapottos M, Janfaza D, Vlassakov K. Ultrasound-guided retrolaminar paravertebral block. Anaesthesia 2013; 68: 649-51.
  13. Murouchi T, Yamakage M. Retrolaminar block: analgesic efficacy and safety evaluation. J Anesth 2016; 30: 1003-7. https://doi.org/10.1007/s00540-016-2230-1
  14. Onishi E, Murakami M, Nishino R, Ohba R, Yamauchi M. Analgesic effect of double-level retrolaminar paravertebral block for breast cancer surgery in the early postoperative period: a placebo-controlled, randomized clinical trial. Tohoku J Exp Med 2018; 245: 179-85. https://doi.org/10.1620/tjem.245.179
  15. Valery P, Aliaksei M. A comparison of the onset time of complete blockade of the sciatic nerve in the application of ropivacaine and its equal volumes mixture with lidocaine: a double-blind randomized study. Korean J Anesthesiol 2013; 65: 42-7. https://doi.org/10.4097/kjae.2013.65.1.42
  16. Rohan B, Singh PY, Gurjeet K. Addition of clonidine or lignocaine to ropivacaine for supraclavicular brachial plexus block: a comparative study. Singapore Med J 2014; 55: 229-32.
  17. Das S, Bhattacharya P, Mandal MC, Mukhopadhyay S, Basu SR, Mandol BK. Multiple-injection thoracic paravertebral block as an alternative to general anaesthesia for elective breast surgeries: a randomised controlled trial. Indian J Anaesth 2012; 56: 27-33. https://doi.org/10.4103/0019-5049.93340
  18. Agarwal RR, Wallace AM, Madison SJ, Morgan AC, Mascha EJ, Ilfeld BM. Single-injection thoracic paravertebral block and postoperative analgesia after mastectomy: a retrospective cohort study. J Clin Anesth 2015; 27: 371-4. https://doi.org/10.1016/j.jclinane.2015.04.003
  19. 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. Anesth Analg 2004; 99: 1837-43. https://doi.org/10.1213/01.ANE.0000136775.15566.87
  20. Kaya FN, Turker G, Mogol EB, Bayraktar S. Thoracic paravertebral block for video-assisted thoracoscopic surgery: single injection versus multiple injections. J Cardiothorac Vasc Anesth 2012; 26: 90-4. https://doi.org/10.1053/j.jvca.2011.09.008
  21. 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. https://doi.org/10.1016/j.rapm.2005.12.004
  22. Onishi E, Toda N, Kameyama Y, Yamauchi M. Comparison of clinical efficacy and anatomical investigation between retrolaminar block and erector spinae plane block. Biomed Res Int 2019; 2019: 2578396. https://doi.org/10.1155/2019/2578396
  23. Costache I, Sinclair J, Farrash FA, Nguyen TB, McCartney CJ, Ramnanan CJ, et al. Does paravertebral block require access to the paravertebral space? Anaesthesia 2016; 71: 858-9. https://doi.org/10.1111/anae.13527
  24. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Reg Anesth Pain Med 2018; 43: 756-62.
  25. Sabouri AS, Crawford L, Bick SK, Nozari A, Anderson TA. Is a retrolaminar approach to the thoracic paravertebral space possible?: a human cadaveric study. Reg Anesth Pain Med 2018; 43: 864-8.
  26. Damjanovska M, Stopar Pintaric T, Cvetko E, Vlassakov K. The ultrasound-guided retrolaminar block: volume-dependent injectate distribution. J Pain Res 2018; 11: 293-9. https://doi.org/10.2147/JPR.S153660
  27. Yang HM, Choi YJ, Kwon HJ, O J, Cho TH, Kim SH. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia 2018; 73: 1244-50. https://doi.org/10.1111/anae.14408
  28. Simpson D, Curran MP, Oldfield V, Keating GM. Ropivacaine: a review of its use in regional anaesthesia and acute pain management. Drugs 2005; 65: 2675-717. https://doi.org/10.2165/00003495-200565180-00013
  29. Hong B, Bang S, Chung W, Yoo S, Chung J, Kim S. Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study. Korean J Pain 2019; 32: 206-14. https://doi.org/10.3344/kjp.2019.32.3.206
  30. Schwenk ES, Mariano ER. Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean J Anesthesiol 2018; 71: 345-52. https://doi.org/10.4097/kja.d.18.00217

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