By Ultrasonic-Guided Erector Spinae Block, Thoracic Paravertebral Block versus Serratus Anterior Plane Block by Articaine with Adrenaline during Breast Surgery with General Anesthesia: A Comparative Study of Analgesic Effect Post-Operatively: Double Blind Randomized, Controlled Trial
• 2019
معلومات البحث
المؤلفون
Ayman Mohamady Eldemrdash, El-Sayed Mohamed Abdelzaam
الكلمات المفتاحية
Anesthesia, Pain, Analgesia, Post-Operative, Articaine, Mastectomy
المجلة العلمية
Not Available
الناشر
Not Available
المجلد
Not Available
العدد
Not Available
الصفحات
Not Available
publication.type
International
رابط البحث
Not Available
المواد المرفقة
Not Available
الملخص
Background and Aims: Erector spinae plane block, Paravertebral block and serratus anterior block are three formats for analgesia post-operatively fol- lowing radical mastectomy. This study compares the analgesic efficacy of these modalities for analgesia post-operatively by articaine 2% with adrena- line. Methods: Seventy-five patients with ASA physical status I or II sub- jected to modified radical mastectomy with axillary clearance were enrolled for the study. After induction of general anaesthesia all patients received 20 mL 2% articaine with adrenaline in each technique of the study. Patients in Group 1 (Erector spinae block [ESB], n = 25), Group 2 paravertebral block [PVB] n = 25), Group 3 (serratus anterior plane block [SAPB] n = 25) were ultrasound-guided on ipsilateral side. Patients were estimated for pain scores at 0, 2, 4, 6, 12 and 24 h, and duration of analgesia post-operatively and re- lieve analgesic doses required of morphine up to 24 h. Results: Visual analogue scale scores post-operatively were lower in ESB and PVB group compared with SAPB at 4, 6, 12 and 24 h (P < 0.05). The first analgesic dose requirement was significantly longer in ESB (416 ± 68 min) than PVB group (371 ± 67 min) in compared with SAPB (343.5 ± 54.7 min). Mean duration of analgesia was significantly longer in ESB and PVB group (P < 0.001) in com- pared with SAPB. Total morphine dose of relieving analgesic was significantly lesser in ESB (4 ± 2 mg) than PVB group (6 ± 2 mg) compared with SAPB (7 ± 2 mg) up to 24 h. ESB was easy technique and has less side effect on com- pared with PVB. As regard block-related complications including (accidental vascular puncture, pneumothorax, nerve damage, local anesthetics toxicity), there were no significant adverse effects noted in three groups. However, only a case of pneumothorax in (PVB) and a two patients’ blood was aspirated when the paravertebral space was entered which required second trial at the blocks. Conclusion: Sonar-guided erector spinae block and thoracic paraver- tebral block minimize post-operative pain scores, prolongs the duration of analgesia and diminishes requirements for assign analgesics in the first 24 h of post-operative period compared to ultrasound-guided serratus anterior plane block but, ESB technique was more potent, easily and less side effect in compared with PVB.
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