Bloqueo paravertebral torácico frente al bloqueopararavertebral torácico más bloqueo de nervios pectoralesen cirugía reconstructiva de mama

Abstract

IntroductionMajor breast surgery was usually performed under general anaesthesia until the first patient series with thoracic paravertebral block was published. This block was introduced into our Hospital, and with the purpose of obtaining a more comfortable perioperative period, it was combined with blocking the pectoral nerves. In this study, both anaesthetic techniques are compared, as regards control of postoperative pain, incidence of postoperative nausea and vomiting, and sedation requirements. Material and methodsAn observational study was conducted with 60 patients scheduled for breast surgery with subpectoral implants (augmentation and /or prosthesis). Two groups were studied. The first (Group I) was randomly selected from a patient records data base to have thoracic paravertebral block and sedation. In the second (Group II), a pectoral nerve block was performed combined with a thoracic paravertebral block. ResultsIn Group I, 33.3% of the patients had a score of ≤ 3 on the visual analogue scale (VAS) at 8hours, and 66.7% had a VAS score of ≥ 4 at 24h, compared to 80% of the Group II patients who had a VAS score of ≤ 3 at 8hours and 20% with a VAS score ≥ 4 at 24h. The mean difference in the VAS scores at 8hours between the two groups was statistically significant: mean VAS score at 8hours in Group I, 4.23±2.4 compared to 1.77±2.2 in Group II. There was no difference in the VAS scores at 24hours. No statistically significant differences were found between the two groups in the incidence of postoperative nausea and vomiting. The need for intra-operative sedation supplements with propofol boluses was less in Group II, 40% compared to 90% in Group II. ConclusionsPectoral nerve block is a technique that improves the results obtained with thoracic paravertebral block in reconstructive breast surgery, with better post-operative analgesic control in the immediate post-operative period and a lower requirement for sedation.