ABSTRACT
Abstract Background Breast cancer surgery is associated with considerable acute post-surgical pain and restricted mobility. Various regional and neuraxial anesthesia techniques have been used to alleviate post-mastectomy pain. Ultrasound-guided serratus anterior plane block (SAPB) has been considered a simple and safe technique. This randomized control study was performed to compare the efficacy of SAPB with the thoracic paravertebral block (TPVB) for postoperative analgesia after breast cancer surgery. Methods A total of 40 adult ASA physical status I - II female patients undergoing radical mastectomy were randomly allocated into two groups to receive either ultrasound-guided TPVB or SAPB with 0.4 mL.kg-1 0.5% ropivacaine, 30 min before surgery. All patients received standardized general anesthesia for surgery. Injection diclofenac and tramadol were used for postoperative rescue analgesia. The time to first rescue analgesia, total analgesic consumption in the first 24 hours, postoperative pain scores, and any adverse effects were recorded. Results The time to first rescue analgesia was significantly longer in the SAPB group (255.3 ± 47.8 min) as compared with the TPVB group (146.8 ± 30.4 min) (p< 0.001). Total diclofenac consumption in 24 hours was also less in the SAPB group (138.8 ± 44.0 mg vs 210.0 ± 39.2 mg in SAPB and TPVB group respectively, p< 0.001). Postoperative pain scores were significantly lower in the SAPB group as compared with TPVB group (p< 0.05). The incidence of PONV was also less in the SAPB group (p= 0.028). No block-related adverse effects were reported. Conclusion We found that the serratus anterior plane block was more effective than the thoracic paravertebral block for postoperative analgesia after breast cancer surgery.
Subject(s)
Humans , Female , Adult , Middle Aged , Breast Neoplasms/surgery , Analgesia , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Diclofenac , Ultrasonography, Interventional/methods , Mastectomy/adverse effectsABSTRACT
BACKGROUND: Breast cancer surgery is associated with considerable acute post-surgical pain and restricted mobility. Various regional and neuraxial anesthesia techniques have been used to alleviate post-mastectomy pain. Ultrasound-guided serratus anterior plane block (SAPB) has been considered a simple and safe technique. This randomized control study was performed to compare the efficacy of SAPB with the thoracic paravertebral block (TPVB) for postoperative analgesia after breast cancer surgery. METHODS: A total of 40 adult ASA physical status I - II female patients undergoing radical mastectomy were randomly allocated into two groups to receive either ultrasound-guided TPVB or SAPB with 0.4â¯mL.kg-1 0.5% ropivacaine, 30â¯min before surgery. All patients received standardized general anesthesia for surgery. Injection diclofenac and tramadol were used for postoperative rescue analgesia. The time to first rescue analgesia, total analgesic consumption in the first 24â¯hours, postoperative pain scores, and any adverse effects were recorded. RESULTS: The time to first rescue analgesia was significantly longer in the SAPB group (255.3⯱â¯47.8â¯min) as compared with the TPVB group (146.8⯱â¯30.4â¯min) (pâ¯<â¯0.001). Total diclofenac consumption in 24 hours was also less in the SAPB group (138.8 ± 44.0 mg vs 210.0 ± 39.2 mg in SAPB and TPVB group respectively, pâ¯<â¯0.001). Postoperative pain scores were significantly lower in the SAPB group as compared with TPVB group (pâ¯<â¯0.05). The incidence of PONV was also less in the SAPB group (pâ¯=â¯0.028). No block-related adverse effects were reported. CONCLUSION: We found that the serratus anterior plane block was more effective than the thoracic paravertebral block for postoperative analgesia after breast cancer surgery.
Subject(s)
Analgesia , Breast Neoplasms , Adult , Breast Neoplasms/surgery , Diclofenac , Female , Humans , Mastectomy/adverse effects , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Ultrasonography, Interventional/methodsABSTRACT
OBJECTIVE: To identify baseline risk factors for prolonged diarrheal duration and subsequent complications in children aged 6 to 59 mo with acute diarrhea who participated in a micronutrient clinical trial in a tertiary care hospital. METHODS: The adjusted odds ratio or incidence risk ratios (IRR) of the baseline variables for prolongation of diarrheal duration (cox proportional hazard model), diarrhea >7 d (multiple logistic regressions), severe dehydration experienced after hospitalization (poisson regression models) was estimated. RESULTS: Fever (OR 1.10, 95% CI 1.02-1.19, p = 0.02), dehydration (OR 1.32, 95% CI 1.10-1.59, p = 0.003), dysentery (OR 1.41 95% CI 1.09-1.82, p = 0.008), those who received medications (OR 1.19, 95% CI 1.03-1.39, p = 0.02), and weight for age Z-score ≤2 (OR 1.25, 95% CI 1.07-1.46, p = 0.004) were at a greater risk of prolonged diarrhea. Diarrhea >7 d was associated with younger age (OR 1.08, 95% CI 1.03-1.14, p = 0.003), female child (OR 2.33, 95% CI 1.19-4.55, p = 0.013), diarrheal duration before enrolment (OR 1.06, 95% CI 1.04-1.09, p < 0.001), fever (OR 1.7, 95% CI 1.23-2.49, p = 0.002) and the weight for age Z-score ≤2 (OR 4.32, 95% CI 2.03-9.16, p < 0.001). Severe dehydration after hospitalization was associated with dehydration at baseline (OR 6.7, 95% CI 2-3.0, p < 0.001), incomplete immunization (OR 3.33, 95% CI 1.5-7.69, p < 0.001), failure to receive any medication(OR 3.03, 95% CI 1.26-7.14, p = 0.01). CONCLUSIONS: Few studies assess risk factors for diarrheal morbidity prospectively. The present study showed that children of acute diarrhea with above risk factors need stricter monitoring for complications to reduce diarrheal mortality.
