ABSTRACT
PURPOSE: Thoracic paravertebral block (TPVB) is an established analgesic technique for breast surgery although it is technically challenging. Erector spinae plane block (ESPB) requires less technical expertise and may be an alternative to TPVB. However, whether ESPB has similar analgesic effects to TPVB for breast surgery is still inconclusive. Moreover, information on sensory blockade of ESPB is scarce. Accordingly, we conducted this retrospective propensity-matched study to see if ESPB could provide comparable analgesic effects to TPVB in patients undergoing breast surgery. We also compared cutaneous sensory block levels after the two techniques. PATIENTS AND METHODS: In this retrospective cohort study, we analyzed data saved in our database and compared the two techniques using a propensity matching method. The data of patients who underwent unilateral breast surgery under general anesthesia with the addition of either TPVB or ESPB were identified. We considered that the analgesic efficacy of ESPB was noninferior to TPVB if both postoperative fentanyl consumption and area under the curve (AUC) for pain scores within 24 h were within 50 µg and 240 mmï½¥h margins, respectively. Cutaneous sensory block levels, additional analgesic requirements, and complications were also compared between the two groups. RESULTS: Among 93 patients, 30 patients for each group were matched. Both postoperative fentanyl consumption and AUC for pain scores after ESPB were noninferior to those after TPVB. ESPB did not produce sensory blockade consistently, and the number of dermatomes was smaller after ESPB [1 (0-3)] [median (interquartile range)] than after TPVB [4 (2-5)] (P=0.002). No serious complications related to blocks were observed. CONCLUSION: ESPB and TPVB provided comparable postoperative analgesia for 24 h in patients undergoing breast surgery. Dermatomal sensory blockade was, however, less apparent and narrower after ESPB than after TPVB.
ABSTRACT
OBJECTIVE: The aim of this study was to investigate the relationships between eruption of deciduous teeth and eating habits determined by health examinations of infants. METHODS: We verified eruption of deciduous teeth based on observations of 455 fourteen-month-old infants at health examinations in a ward of Tokyo, and performed a questionnaire survey involving their mothers regarding the hardness of infants' meals and their eating habits. We examined 420 infants excluding 17 whose births were 'pre-term delivery (born at or before 36 weeks)' and 18 whose questionnaire had excessive omissions. RESULTS: The percentage of infants who began a weaning diet at 5 to 6 months of age was 81.4%, and 71.2% of mothers considered their infant's age in months before starting a weaning diet. We divided the children into three stages: those not showing full eruption of the eight front deciduous teeth (stage I, 27.4%); those with full eruptions of the eight front deciduous teeth excluding the first primary molars (stage II, 61.9%); those with full eruptions of the first primary molars (stage III, 10.7%). Most mothers cooked meals considering the hardness of the gingival gums (stage I; 53.5%, stage II; 54.4%, stage III; 40.0%). The percentage of mothers who cooked meals considering the hardness of the primary molars was 14.0 and 15.1% in stages I and II, respectively. In addition, the percentage who cooked meals while considering the hardness in relation to adult meals was 7.0, 9.7, and 24.4% in stages I, II, and III, respectively. Moreover, the percentage considering the salt-taste in relation to adult meals was 13.2, 17.3, and 22.2% in stages I, II, and III, respectively. CONCLUSION: In the present study, we obtained valuable data showing that the timing deciduous teeth eruption varies among individuals. These results suggested that nutritional education on the appropriate quality of meals for infants based on their state of deciduous teeth eruption is necessary.
