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A Randomized Prospective Trial Comparing Paravertebral Block And General Anesthesia For Operative Treatment Of Breast Cancer
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Book Synopsis A Randomized Prospective Trial Comparing Paravertebral Block and General Anesthesia for Operative Treatment of Breast Cancer by :
Download or read book A Randomized Prospective Trial Comparing Paravertebral Block and General Anesthesia for Operative Treatment of Breast Cancer written by and published by . This book was released on 2000 with total page 153 pages. Available in PDF, EPUB and Kindle. Book excerpt: The goals of the study are to evaluate the role of paravertebral block regional anesthesia in patients undergoing operative treatment of breast cancer. Experience to date has shown that this anesthetic modality is safe and effective, and associated with excellent postoperative pain control and minimization of nausea and vomiting associated with general anesthesia. Using a prospective randomized trial carried out at three institutions, we propose to measure quality of life variables including pain, postoperative nausea and vomiting, mood, and functional status in patients undergoing breast surgery with the traditional techniques of general anesthesia versus the regional technique of paravertebral block. The preliminary phase of this trial, which establishes safety and efficacy in performing the block technique, is ongoing. Once adequate experience in performing the paravertebral block is obtained, we will initiate the study portion of the trial by randomizing patients undergoing surgery to either general anesthesia or paravertebral block. Outcomes will be assessed using validated study instruments, which are included with the report.
Book Synopsis Comparison Of 2 Types Of Ultrasound Guided Nerve Blocks In Patients Undergoing Breast Cancer Surgery Under Opioid Free Anaesthesia by :
Download or read book Comparison Of 2 Types Of Ultrasound Guided Nerve Blocks In Patients Undergoing Breast Cancer Surgery Under Opioid Free Anaesthesia written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Goal of Study: Having demonstrated that PECs ( Pectoral block ) based anesthesia without opioids has decreased analgesic requirement, pain scores and PONV compared to conventional general anesthesia in patients of modified radical mastectomy and axillary dissection (MRM- AD) we wished to compare PECS vs Paravertebral Blocks (PVB) in an opioid free, nerve block based anesthesia. Outcomes of interest were post operative analgesic requirement, duration of analgesia, PONV and satisfaction of patient and surgeons. Materials and Methods: This randomized double blind study involving 58 adult ASA I-III patients posted for MRM-AD in a 500 bedded university hospital. After randomization and allocation concealment patients were induced with propofol and maintained on spontaneous ventilation with isoflurane (0.8- 1.0 MAC) through i-gel. Ultrasound guided PECS or paravertebral blocks (0.1% lignocaine+0.25% bupivacaine+1 mcg /kg dexmedetomidine, 30ml) were administered. Intraoperative events, post-operative pain scores and analgesic requirement over 24 hours, PONV, satisfaction of surgeon and patient were measured. Results- Between the two groups, there was no difference in demographics, ASA status, location and volume of breast tumour excised or the duration of surgery. The time from block to incision was significantly more in the PV group (p = 0.01). There was no difference between the two groups in terms of intra and post operative parameters, and the median VAS scores for pain at rest or during shoulder abduction was similar in both the groups. Discussion- Duration of analgesia is similar between Pecs or PVB block aided opioid free anesthesia for MRM-AD.Time from block to incision is less and surgeon satisfaction better with PECS. This is unlike the results of Wahba et al and Kulhari et al where Pecs block was superior to paravertebral block. Conclusion- Both Pecs and Paravertebral blocks result in prolonged analgesia and decreased requirement of non-opiate opioid analgesics when administered in a opioid free regimen. Pecs block is associated with less time to incision and is preferred by surgeons. Incidence of PONV and complications are low. Benefits of routine used of these blocks to avoid opioid related complications may be studied futher.
Book Synopsis Comparative Study Between Dexmedetomedine and Fentanyl as Adjuvants to Bupivacaine in Paravertebral Analgesia for Breast Surgery by : Ahmed El Beleehy
Download or read book Comparative Study Between Dexmedetomedine and Fentanyl as Adjuvants to Bupivacaine in Paravertebral Analgesia for Breast Surgery written by Ahmed El Beleehy and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: There are hundreds of thousands of breast procedures performed annually; many patients require an overnight stay after surgery for breast cancer for management of postoperative pain, Paravertebral block has been shown to provide improved acute postoperative pain management following breast surgery.Objectives: The aim of our study was to make a comparison between fentanyl and dexmedetmedine as adjuvants to bupivacaine in thoracic paravertebral block in patients undergoing unilateral breast surgery under general anesthesia.Methods: This study was as prospective randomized controlled trial. Sixty adult female patients scheduled for elective elective unilateral modified radical mastectomy under general anesthesia were included and were randomly divided into three groups according to the used adjuvant, The study started by preoperative application of an epidural catheter by using the loss of resistance technique at the fourth thoracic paravertebral space and injection of local anaesthetic started preoperatively, dexmedetomedine group (20ml of bupivacaine 0.5% plus 1u03bcg/kg dexmedetomedine), fentanyl group (20 ml of 0.5% bupivacaine plus fentanyl 2 u03bcg / ml) & control group (20 ml of 0.5% bupivacaine) after that general anaesthesia was started for the three groups. Results: The results revealed significant decrease in the heart rate in the dexmedetomedine group and the fentanyl group than the control; also there was significant decrease in the mean arterial blood pressure in the dexmedetomedine group than the other two groups, there was lower intraoperative fentanyl consumption in patients of the dexmedetomedine group than the fentanyl and the control groups, the dexmedetomedine group had a statistically significant lower postoperative VAS score at rest and during arm movement at all-time intervals with significantly lower demand for post-operative rescue analgesia in comparison with the other groups. Serum cortisol level was significantly lower in the postoperative period in the dexmedetomedine group than the other groups. Nausea and vomiting were reported in significant number of patients in the fentanyl group than the other groups. Conclusions: paravertebral fentanyl and dexmedetomedine in combination with bupivacaine (0.5%) are effective analgesics, At the doses used, there was much lowering of surgical stress response with dexmedetomedine, the addition of fentanyl was associated with nausea and vomiting while dexmedetomedine was associated with arterial hypotension and bradycardia.
Book Synopsis Comparison Between Single Dose Paravertebral Block and Thoracic Epidural Block for Breast Surgeries: a Prospective Randomized Study by : Vishal Krishna Pai
Download or read book Comparison Between Single Dose Paravertebral Block and Thoracic Epidural Block for Breast Surgeries: a Prospective Randomized Study written by Vishal Krishna Pai and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Goal of Study: Both paravertebral block (PVB) and thoracic epidural block(TEB) are established techniques for postoperativepain relief in thoracic and breast surgeries.Breast surgeries are associated with postoperativepain, nausea and vomiting. With medicaladvances and rise in ambulatory surgeries there is a growing interest towards regional anaesthesiafor breast surgeries. Our study compares two known regional techniques with sedation as the soleanaesthetic plan for benign breast surgeries in terms of intraoperative haemodynamics, postoperativepain, side effects and patient satisfaction.Materials and methods: After ethical committee approval, 80 patients scheduled for unilateralsimple mastectomy were randomized to receive either TEB or PVB. The anaesthetic and analgesicprotocols were similar in both groups. Patients in each group received 15 ml of 0.5% Bupivacaineeither in the thoracic paravertebral region or thoracic epidural region. The primary endpointconsisted to measure the frequency of hypotension episodes defined by a mean arterial pressure(MAP) less than 60 mmHg or a decrease in MAP greater than 20% when compared with thepreoperative value. Secondary endpoints evaluated the amount of intraoperative fluid administration,the use of vasopressor drugs, the analgesic efficacy assessed by the visual analogue scale (VAS),any postoperative events such as PONV, shivering or respiratory complications.Results and discussion: As compared to the PVB group the TEB group showed significantdecrease in both mean blood pressure and heart rate during most of the intraoperative period. Theintraoperative fluid consumption was higher in the TEB group as compared to the PVB group. InGroup TEB 25% (10/40) patients required vasopressors as compared to 10% (4/40) in Group PVB.The total rescue analgesic consumption between the two groups were comparable. PostoperativeVAS between the studied groups was similar. Postoperative events in both the groups werecomparable.Conclusion(s): Single injection PVB and TEB had similar quality of surgical anaesthesia, postoperativepain relief and patient satisfaction however PVB had better hemodynamic stability thanTEB in patients undergoing breast surgeries. Further data and studies will be required to confirm thispreliminary study.
Book Synopsis AN EVIDENCE BASED DEPARTMENTAL GUIDELINE FOR PROVISION OF REGIONAL ANAESTHESIA IN BREAST SURGERY by : Rafiq Kanji
Download or read book AN EVIDENCE BASED DEPARTMENTAL GUIDELINE FOR PROVISION OF REGIONAL ANAESTHESIA IN BREAST SURGERY written by Rafiq Kanji and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BackgroundRegional anaesthesia (RA) in breast surgery (BS) reduces post-operative1,2,3 and chronic pain.4 However, the possibility of reduced risk of malignant recurrence5,6 massively furthers its role in Oncoplastic BS and the importance of the Regional Anaesthetist. The neuroendocrine response RA attenuates has multiple pro-malignant effects including depression of cell-mediated immunity, reducing tumour related anti-angiogenic factors and increasing proangiogenic factors.7 Additionally, opioids inhibit cellular and humoral immune function, increase angiogenesis and promote breast tumour growth in rodents. A large randomised-control trial assessing if the aforementioned effects of RA translate into reduced long-term recurrence7 is due to publish its findings imminently. Against this background we devised a guideline to increase and standardise the use of RA in oncological BS.MethodGoogle Scholar provided a literature search. All local Surgeons and Anaesthetists undertaking BS were asked their opinions on RA in BS and their preferred modality thereof. The guideline is thus both evidence based and agreeable to relevant parties.Guideline SummaryIn all malignant BS, a block should be performed. The block should precede surgery. On account of its simplicity,8 superior efficacy,9,10 low complication rate and local favour, PECSII should be the block of choice with an additional PECSI subject to Surgeonu2019s agreement. For axillary dissection, Serratus Anterior block can be offered subject to Surgeonu2019s agreement. Paravertebral and Intrapleural blocks are valid alternatives if PECSI&II are not possible.ConclusionPain reduction alone justifies promotion and standardisation of RA in BS but if oncological benefit is proven, widespread deployment is essential. 1.tBeverly A, Courtney-Evans N, Rudiger J. Analgesia for Breast Surgery: Regional vs. LA infiltration. Poster Presentation ESRA Annual tConference 2017.2.tMoller, JF, Nikolajsen, L, Rodt, SA, et al. Thoracic paravertebral block for breast cancer surgery: a randomized double-blind study. Anesth Analg. 2007; 105: 1848u20131851 3.tBoughey, JC, Goravanchi, F, Parris, RN et al. Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery. Am J Surg. 2009; 198: 720u20137254.tAndreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: A Cochrane systematic review and meta-analysis. Br J Anaesth. 2013; 111: 711u2013205.tHeaney A & Buggy D. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? Brit J Anaesth. 2012; 109: i17- i286.tGarg R. Regional anaesthesia in breast cancer: Benefits beyond pain. Indian J Anaesth. 2017; 61: 369u2013727.tClinicalTrials.gov [Internet]. Sessler D: The Cleveland Clinic (US). 2007 Jan 4 . Identifier NCT00418457, Regional Anaesthesia and Breast Cancer Recurrence; 2007 Jan 4 [cited 2019 Feb 22]. Available from: https://clinicaltrials.gov/ct2/show/study/NCT004184578.tBlanco R. The u201cpecs blocku201d: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011; 66: 847u20138489.tKulhari, S. Bharti N, Bala I et al. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial. Brit J Anaesth. 2016; 117(3): 382 u2013 38610.tWahba, SS & Kamal, SM. Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery. Egypt J Anaesth. 2013; 30: 129u2013135.
Book Synopsis Perioperative Pain Management by : Felicia Cox
Download or read book Perioperative Pain Management written by Felicia Cox and published by John Wiley & Sons. This book was released on 2009-03-17 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Handbook of Perioperative Pain Management is an up-to-date evidence-based guide to the effective management of perioperative pain even in the most challenging situations. It provides readers with an understanding of the physiology, pharmacology and psychology of acute pain together with guidelines for best practice. Examples of assessment documentation and guidelines for specific patient sub-groups are reproduced throughout the text.
Book Synopsis Postoperative Analgesia Requirements After Propofol Anaesthesia with Intercostal Nerve Block Versus Sevofluorane and Opioids for Breast Cancer Surgery by : Veru00f3nica Lu00f3pez Pu00e9rez
Download or read book Postoperative Analgesia Requirements After Propofol Anaesthesia with Intercostal Nerve Block Versus Sevofluorane and Opioids for Breast Cancer Surgery written by Veru00f3nica Lu00f3pez Pu00e9rez and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Comparation of pectoral block/propofol anaesthesia versus sevofluorane/fentanyl anaesthesia for breast cancer surgeryBackground: Breast cancer surgery is one of the most frequently performed surgeries. This include tumorectomies and mastectomies with axillary clearance when needed. Even relatively minor breast surgery can be associated with significant postoperative pain. Thoracic epidural analgesia, paravertebral blocks and other regional techniques are commonly associated to general anaesthesia.Intercostal nerve block (PIB) is another alternative described as particularly useful for ambulatory patients Goal of study: We aim to demostrate that PIB provides better postoperative analgesia than general anaesthesia with sevofluorane and opioids (SAO) with less nausea and vomiting (PONV) and better patient comfort.Material & Methods: 20 women with diagnosis of breast cancer were randomized to recieve either PIB, with 20 ml chirocane 0.25% , performed under ultrasound guidance , or SAO anesthesia. Intraoperative fentanyl consumption, postoperative Visual analogic scale (VAS) pain scores at 1 and 24 h postoperative, postoperative fentanyle consumption, PONV scores and postsurgical hospital stay were recorded.Resultados: Patient demographics and duration of surgery were comparable for both groups(Fig I). PIB group had no need of opioids in the recovery room and presented significantly lower VAS pain scores and less PONV scores.There was no difference in hospital stay or intraoperative fentanyl(Fig 2).Discursion:Intercostal nerve block is easy to perform and is associated to less adverse events then epidural o paravertebral block,
Book Synopsis Chronic Postsurgical Pain by : Gérard Mick
Download or read book Chronic Postsurgical Pain written by Gérard Mick and published by Springer Science & Business Media. This book was released on 2014-02-20 with total page 175 pages. Available in PDF, EPUB and Kindle. Book excerpt: Primum non nocere... The fact that a surgical procedure can leave any kind of pain casts a shadow over this tenet, which is seen as the basis of medical practice and anchor of its principle ethic... It is all the more surprising in that medicine has only paid attention to this paradoxical chronic pain situation for the past few years. Clarifying the knowledge acquired in this field has become all the more urgent for any care-giver today confronted by a legitimate request from patients: Why and how can a surgical procedure, which is supposed to bring relief, leave behind an unacceptable sequela? This is the approach which the contributors to this new subject of major clinical interest invite you to follow as you work your way through this book.
Book Synopsis The Analgesic Efficacy of Continuous Thoracic Paravertebral Block with Clonidine Added to Ropivacaine Early Postoperatively, After Radical Mastectomy by : Iulia Cindea
Download or read book The Analgesic Efficacy of Continuous Thoracic Paravertebral Block with Clonidine Added to Ropivacaine Early Postoperatively, After Radical Mastectomy written by Iulia Cindea and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Goal of Study: We hypothesized that thoracic continuous paravertebral block with ropivacaine and clonidine, as adjuvant, could improve acute postoperative pain management compared to local anaesthetic alone, during first 24h post-procedure in radical mastectomy patients. Materials and Methods: 74 ASA I-III women, candidates to elective radical mastectomy under general anaesthesia, participated in this prospective randomized double-blind study. Prior to surgery, a catheter prepared for postoperative continuous infusion was inserted in T4 paravertebral space in all patients. The patients were randomly allocated to two groups: group S (n=38) with continuous thoracic paravertebral block performed with a bolus of 0.3ml/kg 0.2% ropivacaine followed by 0.1ml/kg/h of local anaesthetic added with 1u00b5g/ml clonidine and, respectively group C (n=36) treated according to the same protocol without clonidine. For postoperative analgesia during study period both groups received PCA with iv morphine.The primary endpoints were the intensity of postoperative pain (VAS) evaluated at 2, 4, 8, 12, 24h and supplemental opioid requirements.The incidence of sedation, nausea vomiting episodes, complications associated to the paravertebral block, hemodynamic parameters and patient satisfaction were documented too, as secondary endpoints. Mann-Whitney test and u03c72 test were used as statistics (p
Book Synopsis Oncoplastic and Reconstructive Surgery of the Breast by : Guidubaldo Querci della Rovere
Download or read book Oncoplastic and Reconstructive Surgery of the Breast written by Guidubaldo Querci della Rovere and published by CRC Press. This book was released on 2010-11-23 with total page 310 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is a timely publication capturing recent developments in the fields of oncoplastic surgery and whole breast reconstruction. The highly successful first edition has been completely updated and expanded by leading oncologists and surgeons, with key features including: A comprehensive account of surgical techniques with over 300 colour figur
Book Synopsis Ultrasound-Guided Regional Anesthesia in Children by : Stephen Mannion
Download or read book Ultrasound-Guided Regional Anesthesia in Children written by Stephen Mannion and published by Cambridge University Press. This book was released on 2015-08-20 with total page 171 pages. Available in PDF, EPUB and Kindle. Book excerpt: The most comprehensive resource available on pediatric ultrasound-guided regional anesthesia, covering core principles and practical guidance for all major blocks.
Book Synopsis Postoperative Analgesia Requirements After Propofol Anaesthesia with Intercostal Nerve Block Versus Sevofluorane and Opioids for Breast Cancer Surgery by : V. López
Download or read book Postoperative Analgesia Requirements After Propofol Anaesthesia with Intercostal Nerve Block Versus Sevofluorane and Opioids for Breast Cancer Surgery written by V. López and published by . This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Comparation of pectoral block/propofol anaesthesia versus sevofluorane/fentanyl anaesthesia for breast cancer surgeryBackground: Breast cancer surgery is one of the most frequently performed surgeries. This include tumorectomies and mastectomies with axillary clearance when needed. Even relatively minor breast surgery can be associated with significant postoperative pain. Thoracic epidural analgesia, paravertebral blocks and other regional techniques are commonly associated to general anaesthesia.Intercostal nerve block (PIB) is another alternative described as particularly useful for ambulatory patients Goal of study: We aim to demostrate that PIB provides better postoperative analgesia than general anaesthesia with sevofluorane and opioids (SAO) with less nausea and vomiting (PONV) and better patient comfort.Material & Methods: 20 women with diagnosis of breast cancer were randomized to recieve either PIB, with 20 ml chirocane 0.25% , performed under ultrasound guidance , or SAO anesthesia. Intraoperative fentanyl consumption, postoperative Visual analogic scale (VAS) pain scores at 1 and 24 h postoperative, postoperative fentanyle consumption, PONV scores and postsurgical hospital stay were recorded.Resultados: Patient demographics and duration of surgery were comparable for both groups(Fig I). PIB group had no need of opioids in the recovery room and presented significantly lower VAS pain scores and less PONV scores.There was no difference in hospital stay or intraoperative fentanyl(Fig 2).Discursion:Intercostal nerve block is easy to perform and is associated to less adverse events then epidural o paravertebral block,
Book Synopsis Issues in Pain Therapies and Research: 2011 Edition by :
Download or read book Issues in Pain Therapies and Research: 2011 Edition written by and published by ScholarlyEditions. This book was released on 2012-01-09 with total page 536 pages. Available in PDF, EPUB and Kindle. Book excerpt: Issues in Pain Therapies and Research / 2011 Edition is a ScholarlyEditions™ eBook that delivers timely, authoritative, and comprehensive information about Pain Therapies and Research. The editors have built Issues in Pain Therapies and Research: 2011 Edition on the vast information databases of ScholarlyNews.™ You can expect the information about Pain Therapies and Research in this eBook to be deeper than what you can access anywhere else, as well as consistently reliable, authoritative, informed, and relevant. The content of Issues in Pain Therapies and Research: 2011 Edition has been produced by the world’s leading scientists, engineers, analysts, research institutions, and companies. All of the content is from peer-reviewed sources, and all of it is written, assembled, and edited by the editors at ScholarlyEditions™ and available exclusively from us. You now have a source you can cite with authority, confidence, and credibility. More information is available at http://www.ScholarlyEditions.com/.
Book Synopsis Essential Clinical Anesthesia Review by : Linda S. Aglio
Download or read book Essential Clinical Anesthesia Review written by Linda S. Aglio and published by Cambridge University Press. This book was released on 2015-01-08 with total page 577 pages. Available in PDF, EPUB and Kindle. Book excerpt: This concise, evidence-based board review book, organized according to the ABA keyword list, covers all the fundamental concepts needed to pass written and re-certification board examinations. Each chapter begins with a case scenario or clinical problem from everyday practice, followed by concise discussion and clinical review questions and answers. Discussion progresses logically from preoperative assessment and intraoperative management to postoperative pain management, enhancing the reader's knowledge and honing diagnostic and clinical management skills. New guidelines and recently developed standards of care are also covered. Serving as a companion to the popular textbook Essential Clinical Anesthesia, this resourceful work reflects the clinical experiences of anesthesia experts at Harvard Medical School as well as individually known national experts in the field of anesthesiology. This practical review is an invaluable resource for anesthesiologists in training and practice, whether studying for board exams or as part of continuing education and ABA recertification.
Book Synopsis Bonica's Management of Pain by : Scott M. Fishman
Download or read book Bonica's Management of Pain written by Scott M. Fishman and published by Lippincott Williams & Wilkins. This book was released on 2012-03-29 with total page 1698 pages. Available in PDF, EPUB and Kindle. Book excerpt: Now in its Fourth Edition, with a brand-new editorial team, Bonica's Management of Pain will be the leading textbook and clinical reference in the field of pain medicine. An international group of the foremost experts provides comprehensive, current, clinically oriented coverage of the entire field. The contributors describe contemporary clinical practice and summarize the evidence that guides clinical practice. Major sections cover basic considerations; economic, political, legal, and ethical considerations; evaluation of the patient with pain; specific painful conditions; methods for symptomatic control; and provision of pain treatment in a variety of clinical settings.
Book Synopsis 3 - COMBINED THORACIC PARAVERTEBRAL AND PECS 2 BLOCK AS AN ALTERNATIVE TO GENERAL ANAESTHESIA FOR MAJOR BREAST SURGERY - A CASE REPORT by : KARTHICK DURAISAMY
Download or read book 3 - COMBINED THORACIC PARAVERTEBRAL AND PECS 2 BLOCK AS AN ALTERNATIVE TO GENERAL ANAESTHESIA FOR MAJOR BREAST SURGERY - A CASE REPORT written by KARTHICK DURAISAMY and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Breast cancer surgery is associated with a significant amount of intraoperative/postoperative pain. Thoracic paravertebral block (PVB) and/or PECS block can provide effective analgesia and are usually combined with general anaesthesia. Awake breast surgery with combined thoracic PVB and PECS-2 block is an effective alternative where general anaesthesia is undesirable.Methods:We present a 77-year-old ASA-3 female with past history of chemo-radiotherapy for laryngeal carcinoma and known difficult airway, scheduled for right mastectomy and sentinel node clearance. She was unwilling to have any form of general anaesthesia and was consented for thoracic-PVB combined with PECS block as mode of anaesthesia for the surgery. Intraoperatively USG paramedian approach thoracic-PVB was performed in the sitting position at two vertebral levels T2-3,T4-5. 10 mls of an equal mixture of 2% lidocaine with epinephrine(1:200000) and 0.5% levo-bupivacaine was administered at each level. Patient was positioned supine and USG PECS 2 block was performed with 10 mls of 0.125% levo-bupivacaine mixed with 5 mls of 1%lidocaine with adrenaline and 10 mls of normal saline.Patient had sedation during the procedure with Propofol TCI and was able to converse throughout surgery maintaining spontaneous ventilation.She subsequently was scheduled few months later for Right axillary node clearance and requested for the same anaesthetic as her previous breast surgery. Similar anaesthetic was provided with good outcome.ResultsOn both the occasions patient was very comfortable in the perioperative period with very minimal postoperative analgesic requirement.Conclusions:Awake major breast surgery can be successfully performed with combination of thoracic PVB and PECS 2 block.
Book Synopsis Comparing Analgesic Requirements After a Non-opiate Anesthesia and an Opiate Anesthesia in Breast Cancer Patients: a Prospective Randomized, Double-blinded, Controlled Trial by : Sarah Saxena
Download or read book Comparing Analgesic Requirements After a Non-opiate Anesthesia and an Opiate Anesthesia in Breast Cancer Patients: a Prospective Randomized, Double-blinded, Controlled Trial written by Sarah Saxena and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Goal of Study: Opioids provide an excellent analgesic effect peri-operatively, however, like every drug, not without side-effects. Post-operative complications, such as respiratory depression, post-operative nausea and vomiting, pruritus, difficulty voiding and ileus are well known.In this study, analgesic requirement was examined after patients received opiate anesthesia and non-opiate anesthesia. Materials and methods: A randomized controlled trial containing two groups with each 33 breast cancer patients undergoing a mastectomy or lumpectomy associated with a total axillary dissection was conducted between 29/09/2014 and 09/07/2015 at the Jules Bordet Institute, Brussels.Per-operative non-opiate analgesia was obtained by combining clonidine (0.2 mcg/kg), ketamine (0.3 mg/kg) and lidocaine (1.5 mg/kg). An extra bolus of ketamine (0.2mg/kg) was given if necessary.Opiate analgesia was obtained via a combination of remifentanil TCI, ketamine (0.3 mg/kg) and lidocaine (1.5 mg/kg). Both groups received IV paracetamol (1000mg/6h) and IV diclofenac (75 mg/12h). Patients received a PCA (patient-controlled analgesia) pump for breakthrough pain during the first 24 hours post-operatively. Clinical characteristics and post-operative piritramide consumption were assessed during the first 24 hours post-operatively.Non parametric Wilcoxon test was used to compare postoperative piritramide consumption.Results and discussion: Data were lacking for two patients in the non-opiate group. A total of 64 patients were included in the study.In the PACU, immediate piritramide usage was 3.0 (2.0-6.0) mg in the opioid free group and 4.6 (4.0-6.0) in the opioid group. (P> 0.05) The total piritramide usage 24 hours post-operatively was 8.1 (2.0-14.5) mg in the non-opiate group and 13.1 (6.0-16.0) mg in the opioid group. (P
