Clinical evaluation of single injection thoracic paravertebral block as A preemptive analgesia in major breast surgery

ABSTRACT

In the current study, we evaluated the use of single injection paravertebral block [PVB] at T4 in females undergoing major breast surgery and to compare it to the conventional method using fentanyl preoperatively. Sixty females ASA I, II were divided into two groups. Group I included 30 females were given Para vertebral block as preemptive analgesia followed by general anaesthesia without any narcotic. Group II included 30 females were given balanced general anesthesia with fentanyl 2micro g/kg. Measurements included continuous ECG, HR, Spo2, NIBP, postoperative nausea and vomiting and postoperative verbal rating score [VRS] for pain hourly postoperatively for the 1st 6 hours then 6 hourly for the first day. Stress hormones [Cortisol, epinephrine and nor epinephrine] and postoperative pulmonary functions were also compared in the two groups. Group II patients [control group] developed a significantly higher incidence of nausea and vomiting. There was no significant difference between heart rates of the two groups at 0 time, whereas there was a significant increase in heart rate in group II at any other time. There was no significant difference in MABP between both groups at 0, 3 times, whereas the MABP of group I was significantly lower than that of group II regarding the rest of time. There was no significant difference between the two groups as regard oxygen saturation at any time. VRS of postoperative pain was significantly higher in group II than that of group I with significant reduction in pethidine requirements in group I patients. During the operation group II patients developed a significant increase in stress hormones levels. In the control group there was a significant percentage reduction in PEFR, FVC and FEV[1] at all times postoperatively. It could be concluded that single injection PVB used during major breast surgery provided higher quality of analgesia with less incidence of postoperative pulmonary complications with early ambulation and haemodynamic stability