scholarly journals COMPARISON OF ULTRASOUND-GUIDED THORACIC PARAVERTEBRAL AND PECTORALIS INTERFASCIAL PLANE BLOCK FOR MODIFIED RADICAL MASTECTOMY

2021 ◽  
Vol 9 (11) ◽  
pp. 73-79
Author(s):  
Kalyani Nilesh Patil ◽  
◽  
Shalini Pravin Sardesai ◽  
Poonam Ghodki ◽  
Rajlaxmi Menghal ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Randomized Study ◽  
Radical Mastectomy ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided

Aims and Objectives : To compare the efficacy of ultrasound-guided thoracic paravertebral block(TPVB) and ultrasound-guided pectoralis interfascial plane (PECS) block for Modified Radical Mastectomy (MRM). The primary objectives were to compare duration of post-operative analgesia and total post-operative analgesic consumption while the secondary objectives were to compare dermatomal spread, intraoperative anaesthesia requirement and patient satisfaction. Materials And Methods: Sixty female patients of American Society of Anaesthesiologists (ASA) physical status I and II, undergoing MRM under general anaesthesia, were randomly recruited to receive ultrasound-guided TPVB (Group T) or ultrasound-guided PECS block (Group P) with 25ml of 0.25% bupivacaine, in a prospective, observer-blinded, randomized study. Data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Categorical variables were compared using the Chi-square test or Fishers exact probability test continuous variables compared using unpaired t-test or Mann-Whitney U test. Results: All demographic variables were comparable. Intraoperative fentanyl consumption was lower in patients who received PECS block (72.50+27.35) than those who received TPVB (104.17+46.92) (p=0.0023). NRS was comparable in both groups till 2 hours post operatively. However, from 4 hours onwards, till 18 hours the Numerical Rating Scale (NRS) was significantly higher in TPVB group. Dermatomal spread was more extensive and postoperative analgesia requirement was lower in Group P. Patient satisfaction was comparable in both groups. Conclusion: PECS block is associated with superior postoperative analgesia and reduced analgesic requirement. The cranial dermatomal spread was better and intraoperative opioid requirement was less with PECS block.

scholarly journals EFFECTIVENESS OF ULTRASOUND-GUIDED MODIFIED PECTORAL NERVE BLOCK (PECS II) FOR POST-OPERATIVE PAIN RELIEF AFTER MODIFIED RADICAL MASTECTOMY (MRM)

2021 ◽  
Vol 71 (3) ◽  
pp. 1011-14
Author(s):  
Azmat Riaz ◽  
Mudasir Saleem ◽  
Khalid Mahmood ◽  
Kaukab Majeed ◽  
Zaki Hussain ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Nerve Block ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Radical Mastectomy ◽  
Control Group ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Pectoral Nerve ◽  
Numerical Rating

Objective: To find the effectiveness of ultrasound guided modified pectoral nerve block (PECS II) versus conventional analgesics for post-operative pain relief in women undergoing modified radical mastectomy. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anaesthesia, Pak Emirates Military Hospital Rawalpindi Pakistan, from May 2018 to Oct 2019. Methodology: A total of 74 adult female patients scheduled for elective unilateral modified radical mastectomy under general anaesthesia were randomized into two groups, pectoral nerve block II (P) group (n=37) and control (C) group (n=37). An ultrasound-guided pectoral nerve block II block was performed using 30 ml of 0.25% Bupivacaine in pectoral nerve block II group after induction of general anaesthesia. In control group (C), patients received only general anaesthesia. Primary outcome measure was opioid consumption in first 24 hours, and the secondary outcome was pain at the breast and axillary region measured using the numerical rating scale (NRS) in first 24 hours at fixed intervals after surgery. Patient satisfaction was evaluated upon discharge using a 4-point scale. Results: Nalbuphine consumption was significantly reduced in pectoral nerve block group as compared to control group. Patients in pectoral nerve block II group experienced much less pain because their numerical rating scale was lower than the control group in postoperative period. Patient satisfaction was found to be high in pectoral nerve block II group. Conclusion: The pectoral nerve block II block is a simple block which provides excellent analgesia for modified radical mastectomy. It can be used for balanced anaesthesia.......

Local Infiltrative Anesthetic Effect of Tramadol Compared to Lidocaine for Excision of Cutaneous Lesions: Pilot Randomized, Double-Blind Clinical Study

2012 ◽  
Vol 16 (2) ◽  
pp. 101-106 ◽  
Author(s):  
Despoina Kakagia ◽  
Theodosia Vogiatzaki ◽  
Savvas Eleftheriadis ◽  
Gregory Trypsiannis ◽  
Christos Iatrou
Keyword(s):  
Injection Site ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Demographic Data ◽  
Randomized Study ◽  
Cutaneous Lesions ◽  
Double Blind ◽  
Lidocaine Group ◽  
Pain Scores

Background: In this double-blind, randomized study, the efficacy of tramadol, an atypical opioid, was tested versus lidocaine in excision of cutaneous lesions of the face. Methods: Eighty-eight patients were randomly assigned to receive either 2 mg/kg tramadol 2% plus adrenaline 1:200,000 (group T, n = 46) or 3 mg/kg lidocaine 2% plus adrenaline 1:200,000 (group L, n = 42) for excision of cutaneous lesions. Pain at the injection site, 2 and 20 minutes postinjection and 3, 6, and 12 hours postoperatively, was monitored on a 0 to 10 numerical rating scale (NRS). Irritation at the injection point and the duration of postoperative analgesia were also recorded. Results: There were no significant differences in demographic data, topography, size of the lesions removed, and operative time between the two groups. A tendency toward lower injection NRS pain scores was observed in group L compared to group T (p = .064). No statistically significant differences between the two groups were found at 2 and 20 minutes postinjection (p = .741 and p = .142, respectively); however, pain scores were significantly higher in group L at 3, 6, and 12 hours postoperatively (all p < .001). Erythema at the injection site was observed in nine group T and two group L patients (p = .076). No postoperative analgesics were required in the tramadol group of patients, whereas acetaminophen with or without codeine was administered in all but five lidocaine group patients during the first 12 hours. Conclusion: Tramadol may be used as a reliable local anesthetic agent, providing longer postoperative analgesia compared to lidocaine; however, it bears a higher incidence of irritation at the injection site.

scholarly journals Role of regional anaesthesia for modified radical mastectomy in a hospital in Central India: a retrospective observational study

2021 ◽  
Vol 8 (6) ◽  
pp. 1854
Author(s):  
Sumit Kumar Gupta ◽  
Arpit Garg ◽  
Sirisha Anne ◽  
Ajit Bhardwaj
Keyword(s):  
Regional Anaesthesia ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Radical Mastectomy ◽  
Central India ◽  
Anaesthetic Management ◽  
Lifestyle Changes ◽  
Erector Spinae ◽  
Modified Radical Mastectomy ◽  
Erector Spinae Plane Block

Background: The number of breast cancer surgeries in India are increasing in the recent years. Lifestyle changes and increased awareness are the two important factors contributing to the same. Newer methods of anaesthetic management are also being practised for overall benefit of the patient. Recent advances in the regional anaesthesia techniques especially under the guidance of ultrasonography, dramatically changed not only the operative outcomes but also the post-operative stay in the hospital. The present study was aimed to bring out differences between two popular options of opioid sparing regional anaesthesia techniques for post-operative analgesia for patients who had undergone modified radical mastectomy (MRM) for carcinoma breast at our centre.Methods: A total of 88 patients of ASA II and III grading were enrolled in the study who had received either of erector spinae plane block (ESB) or thoracic paravertebral block (TPVB). Post-op numerical rating scale for pain and analgesic requirements were compared between the two groups. Hemodynamic parameters were recorded for comparing the influence of the blocks on hemodynamics.Results: The demographic profile was similar between the 2 groups. The study showed that TPVB have a higher efficacy of analgesia when compared with that of ESB. However, there is no significant differences in the intra-op and post-op hemodynamics.Conclusions: In view of a higher safety profile of ESB, administration of the same may still be preferred over the TPVB especially in those with less experienced hands in patients undergoing modified radical mastectomy.

scholarly journals Ultrasound-Guided Transversus Thoracic Muscle Plane-Pectoral Nerve Block for Postoperative Analgesia After Modified Radical Mastectomy: A Comparison with the Thoracic Paravertebral Nerve Block

2021 ◽  
Author(s):  
Ying Zhao ◽  
Weilin Jin ◽  
Peng Pan ◽  
Shuquan Feng ◽  
Danyun Fu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Response ◽  
Nerve Block ◽  
Postoperative Analgesia ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
Ultrasound Guided ◽  
Flurbiprofen Axetil ◽  
Pectoral Nerve ◽  
Fentanyl Consumption

Abstract Background: Modified radical mastectomy (MRM) is a most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain even last for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM.Methods: In this randomized controlled pilot trial, eighty female breast cancer patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n=40) or TPVB (TPVB group, n=40). The primary outcome was 24 h postoperative fentanyl consumption. Secondary outcome measures included intraoperative fentanyl and postoperative flurbiprofen axetil consumption, duration of analgesia, pain intensity at rest and during activity, inflammatory response, and the quality of recovery 40 (QoR-40) score.Results: Intraoperative fentanyl requirement was similar between the two groups; Postoperative fentanyl consumption was decreased in the TTP-PECS group copmared with the TPVB group, as well as the rate of postoperative flurbiprofen axetil consumption, but the duration of analgesia was longer; Pain scores at rest and during activity were dramatically decreased at postoperative 12 h; Moreover, the levels of IL-6, MCP-1 and TNF-α, as well as the levels of PGE2, NPY and β-endorphins were decreased at 12 h after surgery; Finally, the total QoR-40 score, especially for the scores of pain, emotional state and patient support were increased.Conclusion: Both TTP-PECS and TPVB are effective for analgesia after MRM. However, TTP-PECS reduced postoperative fentanyl and flurbiprofen axetil consumption in the first 24 h after MRM, and prolonged the duration of analgesia. Furthermore, TTP-PECS reduced postoperative pain intensity at rest and during activity, and inflammatory response at 12 h postoperation. Finally, TTP-PECS improved QoR-40 scores on the postoperative day. Thus, TTP-PECS is an attractive alternative to TPVB for postoperative analgesia after MRM.

Non-Bullous Pemphigoid: A Single-Center Retrospective Study

Dermatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Agata Moar ◽  
Alan Azzolini ◽  
Gianpaolo Tessari ◽  
Donatella Schena ◽  
Giampiero Girolomoni
Keyword(s):  
Myocardial Infarction ◽  
Bullous Pemphigoid ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Delayed Diagnosis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Aged Patients ◽  
Increased Risk

<b><i>Introduction:</i></b> Bullous pemphigoid (BP) is an autoimmune disease that typically presents with blisters, but sometimes early lesions may be eczematous, maculopapular, or urticarial. The aim of the present study was to highlight possible differences between typical bullous and non-bullous pemphigoid (NBP) and compare results with the literature. <b><i>Material &amp; methods:</i></b> Patients receiving a diagnosis of BP between January 2000 and December 2019 were analyzed. Patients who developed a blister after 3 months from the onset of pruritus were considered as NBP. Demographic features, clinical findings at diagnosis and at 2-year follow-up, histological features, auto-antibodies titers, comorbidities and their treatment were retrieved. Categorical variables were evaluated for normal distribution using a histogram and a Q-Q plot. The χ<sup>2</sup> and Fisher’s exact tests were used to compare categorical variables between the groups. Continuous variables were compared between the groups using analysis of variance and the independent-samples <i>t</i> test. For multivariate analysis, logistic regression was performed. <b><i>Results:</i></b> A total of 532 patients received a diagnosis of BP. A total of 122 patients were enrolled in the study; 63 were females, and the mean age at the diagnosis was 77.2 years (±11.9 SD). 98 were affected by BP and 24 were categorized as NBP. Mean time to diagnosis was 2.9 months (±5.8 SD) for BP and 30.4 months (±59.8 SD) for NBP (<i>p</i> = 0.0001). Skin manifestations in NBP patients were, in order of frequency: urticarial, papular or nodular, eczematous, and excoriations. Pruritus intensity was high but similar in the two groups (Numerical Rating Scale – NRS, 9.3 vs. 8.9). Seven out of 24 NBP patients (29%) never developed blisters; the other patients developed blisters after a mean follow-up time of 24.9 months (±54.9 SD). NBP patients had a more frequent history of myocardial infarction than BP patients (37.5 vs. 10.2%; <i>p</i> &#x3c; 0.003). More NBP patients were taking diuretics than BP patients (66.7 vs. 49%; <i>p</i> = 0.03). NBP patients had a worse response to pruritus compared to BP patients at 2 years (NRS 3.7 vs. 11; <i>p</i> 0.001). <b><i>Conclusions:</i></b> NBP patients have a delayed diagnosis and may be at an increased risk of cardiovascular disease, especially myocardial infarction. Severely and persistently itchy skin disorders in aged patients should be investigated for BP diagnosis.

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