Effects of Paravertebral and Erector Spina Plane Block on Postoperative Opioid Consumption and Pain in Breast Conserving Surgery

Yıl 2023, Cilt: 45 Sayı: 2, 245 - 251, 15.03.2023

Nükhet Sivrikoz , Ebru Emre Demirel Özlem Turhan Dilan Büyük Zerrin Sungur

https://doi.org/10.20515/otd.1217577

Öz

Breast conserving surgery (BCS) is frequently performed in early stage breast cancers. Thoracic paravertebral block (TPVB) is an accepted method in the pain management of breast surgery. In recent years, newly defined ESPB has come to the fore as a safe, easy method with similar analgesic effects. Our study is to compare opioid consumption and analgesia effectiveness of TPVB and ESPB in BCS. The observational prospective study was completed with a total of 85 patients, 43 in Group P(TPVB) and 42 in Group E(ESPB). Blocks were applied at the T4 level with 20 ml of 0.375% bupivacaine under ultrasonography preoperatively. The primary outcome was morphine consumption at postoperative 24 hours, secondary outcomes were postoperative pain scores at 0 and 30 minutes, 1, 4, 6, 12 and 24 hours, need for rescue analgesia, block application times, and nausea-vomiting side effects.Morphine consumption was lower in Group P (17.582.29 mg) than in Group E (18.962.67 mg). (p=0.012) Pain scores at rest and at movement were similar at all times. Rescue analgesia was performed in two patients in Group P and in five patients in Group E. (p>0.05) Block application time was longer in Group P (78.6210.93 seconds) than Group E (57.177.84 seconds). (p<0.001) Nausea was observed in five (11.6%) patients in Group P and in seven (16.7%) patients in Group E. (p>0.05) TPVB and ESPB provided similar analgesic efficacy in BCS. However, ESPB is a good alternative as it is easier to implement.

Anahtar Kelimeler

Postoperative pain, Nerve Block, Thoracic wall

Meme Koruyucu Cerrahi’lerde Torakal Paravertebral ve Erektör Spina Plan Bloğunun Postoperatif Opioid Tüketimi ve Analjezi Etkinliğinin Karşılaştırılması

Öz

Meme koruyucu cerrahi (MKC) erken evre meme kanserlerinde sıklıkla uygulanır. Torakal paravertebral blok (TPVB) meme cerrahileri ağrı yönetiminde etkinliği kabul edilmiş bir yöntemdir. Son yıllarda yeni tanımlanan Erektör Spina Plan Bloğu (ESPB) güvenli, kolay ve benzer analjezik etkileri olan yöntem olarak gündeme gelmiştir. Çalışmamız MKC’lerde TPVB ve ESPB’nin opioid tüketimi ve analjezi etkinliğini karşılaştırmaktadır. Gözlemsel, prospektif olarak Grup P(TPVB)’de 43 ve Grup E(ESPB)’de 42 olmak üzere toplam 85 hasta ile tamamlandı. Bloklar ameliyat öncesinde ultrasonografi altında 20 ml %0.375 bupivakain ile T4 vertebra seviyesinden yapıldı. Birincil sonuç postoperatif 24 saat morfin tüketimi, ikincil sonuçlar postoperatif 0. ve 30. dk, 1., 4., 6., 12. ve 24. saat ağrı skorları, kurtarma analjezi gereksinimi, blok uygulama süreleri ve bulantı kusma yan etkileriydi. Morfin tüketimi Grup P’de (17,582,29 mg) Grup E’den (18,962,67 mg) daha düşüktü. (p=0.012) Tüm zamanlarda istirahat ve hareket ağrı skorları benzerdi. Grup P’de iki hastada, Grup E’de beş hastada kurtarma analjezisi yapıldı. (p>0.05) Blok uygulama süresi Grup P’de (78,6210,93 sn), Grup E’ye göre (57,177,84 sn) daha uzundu. (p<0.001) Grup P’de beş hastada (%11.6) Grup E’de ise yedi (%16.7) hastada bulantı görüldü. (p>0.05) MKC’lerde TPVB ve ESPB benzer analjezik etkinlik sağlamıştır. Ancak ESPB daha kolay uygulanabilir olmasıyla iyi bir alternatiftir.

Anahtar Kelimeler

Postoperatif ağrı, Sinir blok, Torakal duvar

Kaynakça

• 1. Sungu H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209-49.
• 2. Ferlay J, Colombet M, Soerjomataram I, et al. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021;149:778–89.
• 3. Piper M, Peled AW, Sbitany H. Oncoplastic breast surgery: current strategies. Gland Surg. 2015;4:154–63.
• 4. Weber WP, Soysal SD, Fulco I, et al. Standardization of oncoplastic breast conserving surgery. Eur J Surg Oncol. 2017;43:1236-43.
• 5. Zehra S, Doyle F, Barry M, et al. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer. 2020;27:534-66.
• 6. Cali Cassi L, Biffoli F, Francesconi D, et al. Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block. Eur Rev Med Pharmacol Sci. 2017; 21:1341-5.
• 7. Terkawi AS, Tsang S, Sessler DI, et al. Improving Analgesic Efficacy and Safety of Thoracic Paravertebral Block for Breast Surgery: A Mixed-Effects Meta-Analysis. Pain Physician. 2015;18:E757-80.
• 8. Xiong C, Han C, Zhao D, et al. Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis. PLoS One. 2021;16:e0256611.
• 9. Weng WT, Wang CJ, Li CY, et al. Erector Spinae Plane Block Similar to Paravertebral Block for Perioperative Pain Control in Breast Surgery: A Meta-Analysis Study. Pain Physician. 2021;24:203-13.
• 10. Fecho K, Miller NR, Merritt SA, et al. Acute and persistent postoperative pain after breast surgery. Pain Med. 2009;10:708-15.
• 11. Swisher MW, Wallace AM, Sztain JF, et al. Erector spinae plane versus paravertebral nerve blocks for postoperative analgesia after breast surgery: a randomized clinical trial. Reg Anesth Pain Med. 2020;45:260-66.
• 12. Gürkan Y, Aksu C, Kuş A, et al. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial. J Clin Anesth. 2020;59:84-8.
• 13. El Ghamry MR, Amer AF. Role of erector spinae plane block versus paravertebral block in pain control after modified radical mastectomy. A prospective randomised trial. Indian J Anaesth. 2019;63:1008-14.
• 14. Aoyama Y, Sakura S, Tsuchiya R, et al. Erector Spinae Plane Block and Paravertebral Block for Breast Surgery: A Retrospective Propensity-Matched Noninferiority Trial. J Pain Res. 2020;13:2367-76.
• 15. Agarwal S, Bharati SJ, Bhatnagar S, et al. The comparison of the efficacy of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomized controlled trial. Saudi J Anaesth. 2021;15:137-43.
• 16. Moustafa MA, Alabd AS, Ahmed AMM, et al. Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists. Indian J Anaesth. 2020;64:49-54.
• 17. Krediet AC, Moayeri N, van Geffen GJ, et al. Different Approaches to Ultrasound-guided Thoracic Paravertebral Block: An Illustrated Review. Anesthesiology. 2015;123:459-74.
• 18. Neal JM. Ultrasound-Guided Regional Anesthesia and Patient Safety: Update of an Evidence-Based Analysis. Reg Anesth Pain Med. 2016;41:195-204.
• 19. Singh NP, Makkar JK, Kuberan A, et al. Efficacy of regional anesthesia techniques for postoperative analgesia in patients undergoing major oncologic breast surgeries: a systematic review and network meta-analysis of randomized controlled trials. Can J Anaesth. 2022;69:527-49.
• 20. Niesen AD, Jacob AK, Law LA, et al. Complication rate of ultrasound-guided paravertebral block for breast surgery. Reg Anesth Pain Med. 2020;45:813-17.
• 21. Elewa AM, Faisal M, Sjöberg F, et al. Comparison between erector spinae plane block and paravertebral block regarding postoperative analgesic consumption following breast surgery: a randomized controlled study. BMC Anesthesiol. 2022;22:189.