A Prospective Comparison of Continuous Wound Infiltration with Ropivacaine Versus Single-Injection Paravertebral Block After Modified Radical Mastectomy

Autor: Oreste Claudio Buonomo, Alessandro Fabrizio Sabato, Tatiana Sidiropoulou, Georgia Kostopanagiotou, Maria Beatrice Silvi, Mario Dauri, Eleonora Fabbi
Rok vydání: 2008
Předmět:
Time Factors
medicine.medical_treatment
Ropivacaine
Prospective Studies
Anesthetics
Local
Injections
Spinal
Mastectomy
Pain Measurement
Infusions
Intralesional
Pain
Postoperative
Analgesics
Morphine
Local anesthetic
Nerve Block
Middle Aged
Intralesional
Analgesics
Opioid
Continuous wound infiltration
Treatment Outcome
Local
Patient Satisfaction
Anesthesia
Female
medicine.symptom
medicine.drug
Shoulder
Infusions
medicine.medical_specialty
Spinal
medicine.drug_class
Breast surgery
Analgesic
Pain
Breast Neoplasms
Opioid
Modified Radical Mastectomy
Drug Administration Schedule
Injections
Mastectomy
Modified Radical
medicine
Humans
Paravertebral Block
Postoperative
Postoperative Nausea and Vomiting
Recovery of Function
Aged
Amides
Anesthetics
business.industry
Modified Radical
Surgery
Settore MED/18 - Chirurgia Generale
Anesthesiology and Pain Medicine
business
Postoperative nausea and vomiting
Zdroj: Anesthesia & Analgesia. 106:997-1001
ISSN: 0003-2999
Popis: BACKGROUND: The efficacy of continuous wound infiltration with local anesthetic has not been compared with that of thoracic paravertebral block (PVB) after breast surgery. In this study, we evaluated the analgesic efficacy and morphine consumption of the two techniques after mastectomy. METHODS: Forty-eight patients undergoing modified radical mastectomy with axillary dissection were randomly assigned to either a preoperative PVB with 20 mL of ropivacaine 0.5% (group PVB) or a continuous ropivacaine 0.5% infusion (CRI) at a 2 mL/h rate for each of two multilumen catheters placed subcutaneously at the end of the procedure (group CRI). The catheters were left in place for 24 h postoperatively. A standardized general anesthetic was administered to all patients. Postoperative morphine consumption, pain scores and painful restricted movement of the shoulder for 24 h postoperatively as well as incidence of adverse events, including postoperative nausea and vomiting, were recorded. RESULTS: Morphine consumption was similar between groups (PVB: 42.6 11 vs CRI: 38.7 11 mg in 24 h, P 0.225). Absolute pain scores were low in both groups. Four hours after surgery, group PVB showed a significant reduction in postoperative pain (PVB: 0 [0–10] vs CRI: 0 [0–30], P 0.002) and reduced painful restricted movement (P 0.004), whereas the CRI group had lower pain scores (PVB: 10 [0–30] vs CRI: 0 [0–20], P 0.034) and painful restricted movement (P 0.043) 16 and 24 h (PVB: 10 [0–30] vs CRI: 0 [0–30], P 0.012) after surgery. Postoperative nausea and vomiting was significantly more frequent in the CRI group (P 0.017). CONCLUSIONS: Continuous wound infiltration of local anesthetics is an effective alternative to paravertebral analgesia after mastectomy with axillary dissection. (Anesth Analg 2008;106:997‐1001)
Databáze: OpenAIRE
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