SINGLE NEEDLE THORACIC PARAVERTEBRAL BLOCK AS AN ALTERNATIVE TO GENERAL ANESTHESIA FOR MODIFIED RADICAL MASTECTOMY OPERATION : A RANDOMISED CONTROL STUDY

Abstract

Background and Aims: Conventionally, surgery for breast carcinoma is done under general anaesthesia (GA). Recently thoracic paravertebral block (TPVB) is gaining popularity because it produces unilateral block and minimal haemodynamic changes. It also facilitates post-op analgesia, early ambulation, and reduces hospital stay. Aim was to observe effectiveness of single needle TPVB with bupivacaine as the sole anaesthetic technique for Modied radical mastectomy (MRM). Methods: 60 consenting female patients of ASA I & II, aged 18-60 years scheduled for modied radical mastectomy were randomly assigned into two groups: Gr. P (n=30), Gr. G(n=30). For Gr. P: TPVB was given at T4 vertebral level with 18G Tuohy needle and an epidural catheter inserted 2- 3cm inside the paravertebral space. Bupivacaine 0.5% isobaric 15-20ml (not exceeding 2 mg/kg b.w.) injected through the epidural catheter. Dexmedetomidine infusion given for sedation. Gr. G: GA was given with Midazolam, Fentanyl, Propofol and Atracurium. Measured parameters were baseline and intraoperative haemodynamics , induction time, recovery time, fentanyl requirement, average blood loss, post-op pain score by VAS at 0,1/2,1,2,4,8,12,24hrs, duration of analgesia, patient and surgeon satisfaction scores(PSS,SSS),and incidence of post-op nausea vomiting(PONV). RESULTS: Group P patients had prolonged induction ( ) and recovery was faster ( ) in comparison to 12.25±3.66 1.61±0.69 group G. Intraoperatively Group P patients required less Fentanyl & also had less blood loss. Post op VAS score, incidence of PONV were more in group G. Conclusion: TPVB may be used as an alternate anaesthetic technique for MRM as it provides adequate analgesia both in intra and post op period with minimal adverse effects.