The Ultrasound Guided Multiple Injection Costotransverse Block For Postoperative Pain Management With Major Breast Cancer Surgery Case Reports

Author : Eduardo Allu00f3
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)

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Download or read book ESP BLOCK FOR ONCOLOGIC BREAST SURGERY: CAN IT BE USED AS A REGIONAL ANESTHESIA TECHNIQUE? written by Eduardo Allu00f3 and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: ESP BLOCK FOR ONCOLOGIC BREAST SURGERY: CAN IT BE USED AS A REGIONAL ANESTHESIA TECHNIQUE?Juan Carlos Sosa Nicora, Adriana Inu00e9s Acosta, Eduardo Allu00f3Background and Aims:The Erector Spinae Plane (ESP) is a promising block whose mechanisms are not yet fully understood. 1 Since the ESP was first described by Mauricio Forero in 20162, many case reports have been published. Most of them have proven to be useful as part of mutimodal approach in analgesia. 3,4 Only a couple of case reports are available that describe the use of ESP without general anesthesia.5,6 In this case series we present the ESP technique with a continous catheter (E-Cathu00ae - Pajunk, 2018)7 as a standalone option in oncologic breast surgery.Methods:Patient Selection:Thirteen consecutive patients that were suspected or diagnosed with breast cancer determined by clinical features, physical examination, image studies and/or fine needle aspiration studies and were scheduled to undergo surgical intervention during april 2018 and april 2019 were candidates for this study according to the inclusion and exclusion criteria shown in Table 1. Thirteen patients recieved the ESP block along with complementary endovenous sedation in five different hospitals. Same surgical team undertook all of these surgeries. The technique was explained to the patient by the anesthesiologist before the intervention and Informed Consent was signed by both. Primary outcome was set as the need to convert to general anesthesia. The ESP was performed according to Forerou00b4s2 description; localization of T5 transverse process, with the patient in the sitting position under ultrasound guidance by single shot injection of 20 ccu00b4s of 2% lidocaine followed by continous plexus catheter placement. An aditional bolus of 10 cc was administered during surgery if procedure aproximated 60 minutes of duration.Time latency of between 10 and 30 minutes after full dose administration was allowed before skin incision. During this time patient was kept awake and monitored for systemic toxicity of local anesthesic. After latency period, surgery was initiated with an intermitent tegumentary testing incision with the patient sedated. If surgeon needed to administer additional local anesthesic at any point during skin incision, this was noted. Deep plane anesthesia was also noted.After surgery concluded, patient was awakened and asked to move the ipsilateral arm to rule out motor blockade. For post operative analgesia, either a bolus of 10 ccu00b4s of levobupivacaine 0,25% or ropivacaine 0,2% with 0,1 mgr/cc of dexamethasone was administered.Final duration of surgical intervention was noted and patient was taken to the PACU for 20 minutes and later to the ward. Patient recieved ketorolac 30 mgr IV or methamizole 2 Gr. IV TID and tramadol PRN. Hospital discharge was planed 24 hs after the procedure and number of administered rescue doses were noted.Funding of this study was provided by the surgical team if not covered by the patientu00b4s private health insurance company.Results:Twelve women and one man wtih a mean age of 64 (36-87) underwent surgical interventions of the breast and axilar region (Table 2). Latency time averaged 23 minutes (15-30). Lower latency times were related with use of local anesthesic by the surgeon (4 cases in superficial skin plane). Average intervention time was 70 minutes (45-120) and additional bolus of intraoperative lidocaine was administered in 7 patients.No patient required conversion to general anesthesia nor rescue analgesia in the post operative period. The last patient in the series was a high risk patient (severe valvulopathy, high ELVDP and CKD ) so she recieved analgesia through an elastomeric pump and NSAIDs were spared. All patients were discharged after 24 hours without complications.Conclusions:ESP block can be used as local anesthesia for oncologic breast surgery using a continuos catheter . This technique can provide good post operative analgesia and can be used as the sole strategy for post operative analgesia . Further studies are needed to evaluate overall safety for this procedure since high doses of Local Anesthesics are required.References:1.- Erector spinae plane block: an innovation or a delusion?Korean J Anesthesiol. 2019;72(1):1-3. Published online January 31, 2019DOI: https://doi.org/10.4097/kja.d.18.00359 2.- Forero M, Adhikary SD, Lopez H, Tsul C, Chin KJ. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. Reg Anaesth Pain Med. 2016;41:621u201373.- Kwon WJ, Bang SU, Sun WY. Erector spinae plane block for effective analgesia after total mastectomy with sentinel or axillary lymph node dissection: a report of three cases. J Korean Med Sci 2018; 33: e291.u20284.- Altu0131parmak B, et al. Ultrasound guided erector spinae plane block for postoperative analgesia after augmentation mammoplasty: case series. Rev Bras Anestesiol. 2019. https://doi.org/10.1016/j.bjane.2018.12.008 5.-Kimachi PP, Martins EG, Peng P, Forero M. The erector spinae plane block provides complete surgical anesthesia in breast surgery: a case report. A A Pract. 2018;11:186u20138. u20286.- De Cassai A, Marchet A, Ori C. The combination of erector spinae plane block and pectoralis blocks could avoid general anesthesia for radical mastectomy in high risk patients. Minerva Anestesiol. 2018; 84:1420-14217.- Ip V. H. Y. et al. The catheter-over-needle assembly offers greater stability and less leakage compared to the traditional counterpart in continuous interscalene nerve blocks: a randomized, patient-blinded study, Can. J. Anesth. 2013; 60: 1272u20131273Table 1a. Inclusion CriteriaMinimum age, 18 yearsSuspected or Diagnosed Breast Nodule, Tumor or Lymph Nodes Scheduled for Non-Reconstructive Oncologic Breast Surgery Table 1b. Exclusion CriteriaAbnormal Coagulation TestsKnown or suspected history of allergic reactions to Local Anesthesics Patient Refusal.