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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

Korean Journal of Pain 2020년 33권 4호 p.378 ~ 385
황부영, 김은수, 권재영, 이지연, 이도원, 박은지, 강태우,
소속 상세정보
황부영 ( Hwang Boo-Young ) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
김은수 ( Kim Eun-Soo ) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
권재영 ( Kwon Jae-Young ) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
이지연 ( Lee Ji-Youn ) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
이도원 ( Lee Do-Won ) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
박은지 ( Park Eun-Ji ) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
강태우 ( Kang Tae-Woo ) - Pusan National University Hospital Busan Cancer Center

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.

키워드

Analgesics; Opioid; Anesthetics; Local; Breast Neoplasms; Injections; Spinal; Nerve Block; Pain; Postoperative; Ropivacaine; Ultrasonography; Interventional; Visual Analog Scale

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