Paravertebral Block Versus Erector Spinae Plane Block for Analgesia in Modified Radical Mastectomy
NCT ID: NCT05080985
Last Updated: 2021-10-18
Study Results
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Basic Information
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COMPLETED
NA
86 participants
INTERVENTIONAL
2018-11-20
2020-03-01
Brief Summary
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Detailed Description
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All patients in the operating room has same anesthetic management under standard monitoring modalities. Prior to regional technique, mild sedation was achieved with midazolam (1-2 mg) and fentanyl (50 mcg). Both blocks were performed under ultrasonography guidance from the level of T4 vertebra with a linear probe (5MHz; GE Healthcare, Wauwatosa, Wis, USA) using longitudinally out-of-plane technique by an anesthesiologist. A 22-gauge, 50 mm insulated stimulating needle was used.By using reference points of C7 and T7, spinous processes of thoracic vertebras were marked. 10% povidone iodine was used for skin antisepsis. USG probe was longitudinally placed at the level of T4. Staff anesthesiologist had to visualize of adjacent muscles, transverse process (TP) and pleura.
For ESPB; confirmation of the needle position was achieved with spread of 2 ml saline between the deep fascia of the erector spinae muscle and the TP. After negative aspiration 20 ml 0.375% bupivacaine was injected with appropriate distribution of LA.
For TPVB; the needle was advanced passing over superior costotransverse ligament and target space was confirmed by the downward displacement of pleura after the administration of 2 ml 0.9% NaCl. After negative aspiration, 20 ml 0.375 % bupivacaine was injected with appropriate distribution of local anesthetics.
Vascular puncture, haematoma, neuraxial injury and pneumothorax were defined as block complications and should be noted.
30 minutes after the block achieved, pinprick test was performed on both mid-axillary and midclavicular lines from T1 to T12 (0 there is sensation, 1 decreased sensation, 2 there is no sensation).
Anesthesia induction was unique for all patients with 0.03 mg kg-1 midazolam, 0.5 mcg kg-1 fentanyl, 2 mg kg-1 propofol and 0.6 mg kg-1 rocuronium. Maintenance was achieved with sevoflurane of 1 minimum alveolar concentration in a mixture of 40% O2 and 60% N2O. As a component of multimodal analgesia, paracetamol (1 gr) was applied to all patients before skin incision.
Hemodynamic data were recorded throughout surgery. An increase more than 20% from baseline in mean arterial pressure (MAP) was defined as inadequate analgesia and was treated with bolus fentanyl (50 mcg). Hypotension was described with a decrease more than 20% in MAP and treated with ephedrine bolus. Bradycardia was determined with a heart rate (HR) less than 50 beats min-1 and treated with atropine. At the end of surgery, the patients were extubated in operating room.
Postoperative analgesia was achieved with IV morphine via Patient Controlled Analgesia (PCA) for 24 hours (0.01 mg kg-1 h-1 basal infusion, 1 mg bolus, 20 minutes lock-out time).
Postoperative follow-up included hemodynamic variables as well as pain scores and morphine consumption. Adequate analgesia at rest (static) and at moving of the arm interpreted as 45-90 degree abduction (dynamic) was investigated with Numeric Rating Scale (NRS) at 30th minute and 1st, 4th, 6th, 12th, 24th hours postoperatively. When NRS was 4 and higher, tramadol should be administered as rescue analgesic. In case of insufficient pain control at 30th minute, dermatomal analgesia should be assessed for both mid-axillary and midclavicular lines from T1 to T8 by pinprick test (0 there is sensation, 1 decreased sensation, 2 there is no sensation). Morphine consumption was evaluated at same study times.
Complications were determined as sedation assessed by Ramsey scale, postoperative nausea- vomiting (PONV) assessed with the four-point categorical scale (0=no PONV, 1=mild nausea, 2=severe nausea or vomiting once, and 3=vomiting more than once). Severe vomiting should be treated in a multimodal way and excluded from the study (category 2,3).
Staff anesthesiologist responsible for operative course did not contribute in analgesia assessment, nor in other postoperative follow-up. Other investigators who were blinded to operative management, collected postoperative data.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
DOUBLE
Study Groups
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Group P : TPVB
Thoracic paravertebral block
TPVB
20 ml 0.375 % bupivacaine was injected between superior costotransverse ligament and pleura.
Bupivacain
20 ml 0.375 % bupivacaine was injected
Group E : ESPB
Erector spinae plane block
ESPB
20 ml 0.375 % bupivacaine was injected between deep fascia of the erector spinae muscle and transverse process.
Bupivacain
20 ml 0.375 % bupivacaine was injected
Interventions
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TPVB
20 ml 0.375 % bupivacaine was injected between superior costotransverse ligament and pleura.
ESPB
20 ml 0.375 % bupivacaine was injected between deep fascia of the erector spinae muscle and transverse process.
Bupivacain
20 ml 0.375 % bupivacaine was injected
Eligibility Criteria
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Inclusion Criteria
* ages 18-75 years
* American Society of Anesthesiologists (ASA) classification I-III
Exclusion Criteria
* chronic analgesic use
* diabetes mellitus
* body mass index of (BMI) \> 35 kg/m2.
18 Years
75 Years
FEMALE
No
Sponsors
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Istanbul University
OTHER
Responsible Party
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Nukhet Sivrikoz
Attending Anesthesiologist
Principal Investigators
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Nükhet Sivrikoz
Role: PRINCIPAL_INVESTIGATOR
Attending anesthesiologist
Locations
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Istanbul University, Istanbul Faculty of Medicine
Istanbul, , Turkey (Türkiye)
Countries
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References
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Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451.
Other Identifiers
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2018-1608
Identifier Type: -
Identifier Source: org_study_id