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Original Research

Open Access

Ultrasound-guided thoracic paravertebral nerve block in patients undergoing radical mastectomy

  • Lin Shen1
  • Yansong Xu1
  • Jiayu Lu1
  • Wei He1,*,

1Department of Anesthesiology, The Affiliated Hospital of Beihua University, 132011 Jilin, Jilin, China

DOI: 10.22514/ejgo.2023.083 Vol.44,Issue 5,October 2023 pp.90-96

Submitted: 07 June 2023 Accepted: 11 July 2023

Published: 15 October 2023

*Corresponding Author(s): Wei He E-mail: whe2488@163.com

Abstract

This research aims to investigate the effect of ultrasound-guided continuous thoracic paravertebral nerve block in patients undergoing radical mastectomy. Ninety-six patients who underwent radical mastectomy were equally divided into a study group (administered with a continuous thoracic paravertebral nerve block and general anesthesia) and a control group (given conventional general anesthesia) with a random number table. At T2–T4 (T2: immediate tracheal intubation; T3: at skin incision; T4: at extubation), mean artery pressure (MAP) and hear rate (HR) were significantly lower in the study group (p < 0.05); however, there was no significant difference in blood oxygen saturation (SpO2) between the two groups at different time points. At T2–T4, cortisol (Cor) levels were significantly lower in the study group (p < 0.05). At T0–T2, there was no significant difference in the levels of adrenocorticotropic hormone (ACTH) between the two groups. At T3–T4, the levels of ACTH in the study group were significantly lower (p < 0.05). There were no significant differences in blood pressure between the two groups at any time point. At the moment of discharge from the resuscitation room and 2 hours after surgery, the numerical rating scale (NRS) score in the study group was significantly reduced (p < 0.05). The incidence of adverse reactions in the study group was 10.42%; this was lower than that in the control group (33.33%) (p < 0.05). Finally, the use of fentanyl and propofol, and the frequency of analgesic pump use, were significantly lower in the study group (p < 0.05). Ultrasound-guided thoracic paravertebral nerve block can effectively maintain hemodynamic stability, improve the stress response, reduce postoperative pain, reduce the use of anesthetic drugs, and effectively control the incidence of adverse reactions in patients undergoing radical mastectomy.


Keywords

Hemodynamics; Parathoracic nerve block; Radical cure of breast cancer; Stress response; Ultrasound guidance


Cite and Share

Lin Shen,Yansong Xu,Jiayu Lu,Wei He. Ultrasound-guided thoracic paravertebral nerve block in patients undergoing radical mastectomy. European Journal of Gynaecological Oncology. 2023. 44(5);90-96.

References

[1] Bakeer AH, Kamel KM, Abdelgalil AS, Ghoneim AA, Abouel Soud AH, Hassan ME. Modified pectoral nerve block versus serratus block for analgesia following modified radical mastectomy: a randomized controlled trial. Journal of Pain Research. 2020; 13: 1769–1775.

[2] Lin X, Cai Y, Chen X, Lin J, He Y, Xie L, et al. Analgesia and stress attenuation of ultrasound-guided modified pectoral nerve block type-II with different volumes of 0.3% ropivacaine in patients undergoing modified radical mastectomy for breast cancer: a prospective parallel randomized double-blind controlled clinical trial. Journal of Clinical Pharmacy and Therapeutics. 2022; 47: 1676–1683.

[3] Funcke S, Schick-Bengardt X, Pinnschmidt HO, Beyer B, Fischer M, Kahl U, et al. The impact of spinal anaesthesia on perioperative opioid consumption, postoperative pain and oncological outcome in radical retropubic prostatectomy-a retrospective before-and-after effectiveness study. Perioperative Medicine. 2022; 11: 49.

[4] Pikramenos K, Zachou M, Apostolatou E, Papadopoulos D, Mitsogianni M, Papatsoris A, et al. The effects of method of anaesthesia on the safety and effectiveness of radical retropubic prostatectomy. Archives of Italian Urology and Andrology. 2022; 94: 396–400. (In Italian)

[5] Shah S, Chawla R, Pahade A, Mittal A, Bhargava A, Kumar R. Comparison of pectoralis plane blocks with ketamine-dexmedetomidine adjuncts and opioid-based general anaesthesia in patients undergoing modified radical mastectomy. Indian Journal of Anaesthesia. 2020; 64: 1038–1046.

[6] Cong X, Huang Z, Zhang L, Sun M, Chang E, Zhang W, et al. Effect of different anaesthesia methods on perioperative cellular immune function and long-term outcome in patients undergoing radical resection of esophageal cancer: a prospective cohort study. American Journal of Translational Research. 2021; 13: 11427–11438.

[7] Jiao R, Peng S, Wang L, Feng M, Li Y, Sun J, et al. Ultrasound-guided quadratus lumborum block combined with general anaesthesia or general anaesthesia alone for laparoscopic radical gastrectomy for gastric adenocarcinoma: a monocentric retrospective study. International Journal of General Medicine. 2022; 15: 7739–7750.

[8] Bhan S, Mishra S, Gupta N, Garg R, Vig S, Thulkar S, et al. A Prospective randomised study to assess the analgesic efficacy of serratus anterior plane (SAP) Block for modified radical mastectomy under general anaesthesia. Turkish Journal of Anaesthesiology and Reanimation. 2021; 49: 124–129.

[9] Bhoi D, Jain D, Chhabra A, Mohan VK, Talawar P, Kataria K. Analgesic efficacy of superficial versus deep serratus plane block for modified radical mastectomy under general anaesthesia: a randomised comparative study. Indian Journal of Anaesthesia. 2022; 66: S307–S313.

[10] Zhao Y, Jin W, Pan P, Feng S, Fu D, Yao J. Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modified radical mastectomy: a comparison with the thoracic paravertebral nerve block. Perioperative Medicine. 2022; 11: 39.

[11] Liu X, An J. Effects of serratus anterior plane block and thoracic paravertebral nerve block on analgesia, immune function and serum tumor markers in patients after thoracoscopic radical resection of lung cancer. Nagoya Journal of Medical Science. 2022; 84: 506–515.

[12] Bowness J, El-Boghdadly K, Burckett-St Laurent D. Artificial intelligence for image interpretation in ultrasound-guided regional anaesthesia. Anaesthesia. 2021; 76: 602–607.

[13] Chuan A. Education and training in ultrasound-guided regional anaesthesia and pain medicine. Current Opinion in Anaesthesiology. 2020; 33: 674–684.

[14] Niang DGM, Gaba FM, Diouf A, Hendricks J, Diallo RN, Niang MDS, et al. Galectin-3 as a biomarker in breast neoplasms: Mechanisms and applications in patient care. Journal of Leukocyte Biology. 2022; 112: 1041–1052.

[15] Uccella S, Finzi G, Sessa F, La Rosa S. On the endless dilemma of neuroendocrine neoplasms of the breast: a journey through concepts and entities. Endocrine Pathology. 2020; 31: 321–329.

[16] Wei S. Update on selective special types of breast neoplasms: focusing on controversies, differential diagnosis, and molecular genetic advances. Seminars in Diagnostic Pathology. 2022; 39: 367–379.

[17] Zhao X, Yang G, Zhang W, Dong Q, Yang Q. Age-related risk for second breast cancer and gynecological malignant neoplasms after differentiated thyroid cancer. Endocrine. 2022; 76: 385–394.

[18] Abu Elyazed MM, Mostafa SF. Continuous pectoral nerve block compared with continuous thoracic paravertebral block and intravenous opioid analgesia for the postoperative analgesic efficacy in patients undergoing modified radical mastectomy: a prospective randomized trial. The Clinical Journal of Pain. 2021; 37: 359–365.

[19] Wang Q, Guo J, Hou M. Effect of intercostal nerve block combined with oxycodone on the postoperative cognitive ability in elderly patients undergoing radical resection of lung cancer. American Journal of Translational Research. 2022; 14: 6277–6285.

[20] Chuan A, Jeyaratnam B, Iohom G, Shorten G, Lee P, Miglani S, et al. Using psychometric ability to improve education in ultrasound‐guided regional anaesthesia: a multicentre randomised controlled trial. Anaesthesia. 2021; 76: 911–917.

[21] Hewson DW, Bedforth NM. Closing the gap: artificial intelligence applied to ultrasound-guided regional anaesthesia. British Journal of Anaesthesia. 2023; 130: 245–247.

[22] Kang K, Meng X, Li B, Yuan J, Tian E, Zhang J, et al. Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery. World Journal of Surgical Oncology. 2020; 18: 298.

[23] Wang Y, Hu H, Feng C, Liu D, Ding N. Effect of ultrasound-guided quadratus lumborum block preemptive analgesia on postoperative recovery of patients with open radical colon cancer surgery: a retrospective study. Cancer Management and Research. 2021; 13: 6859–6867.

[24] Zhang W, Li J, Huang Y, Huang N, Huang F, Huang Q, et al. The median effective volume of ultrasound-guided thoracic paravertebral nerve block with 0.3% ropivacaine in radical thoracoscopic surgery for lung cancer. Technology and Health Care. 2022; 30: 1343–1350.

[25] Erickson AM, Lokman U, Lahdensuo K, Tornberg S, Visapaa H, Bergroth R, et al. PTEN and ERG expression in MRI-ultrasound guided fusion biopsy correlated with radical prostatectomy findings in men with prostate cancer. The Prostate. 2020; 80: 1118–1127.

[26] Wang X, Ran G, Chen X, Xie C, Wang J, Liu X, et al. The effect of ultrasound-guided erector spinae plane block combined with dexmedetomidine on postoperative analgesia in patients undergoing modified radical mastectomy: a randomized controlled trial. Pain and Therapy. 2021; 10: 475–484.

[27] Liang M, Xv X, Ren C, Yao Y, Gao X. Effect of ultrasound-guided transversus abdominis plane block with rectus sheath block on patients undergoing laparoscopy-assisted radical resection of rectal cancer: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiology. 2021; 21: 89.

[28] Xu D, Luo W. Effect of ropivacaine combined with small doses of triamcinolone and continuous nerve block of unilateral paravertebral canal guided by ultrasound on metastasis after radical treatment of lung cancer. Journal of Oncology. 2022; 2022: 1–9.

[29] Xu X, Chen X, Zhu W, Zhao J, Liu Y, Duan C, et al. Efficacy and safety of ultrasound guided-deep serratus anterior plane blockade with different doses of dexmedetomidine for women undergoing modified radical mastectomy: a randomized controlled trial. Frontiers in Medicine. 2022; 9: 819239.

[30] Hu Y, Li M, Li J, Lyu Q, Jiang R, Du Y. Effects of ultrasound-guided erector spinae plane block on the immune function and postoperative recovery of patients undergoing radical mastectomy. Gland Surgery. 2021; 10: 2901–2909.

[31] Ji X, Cui W, Shan S, Liu X, Wang L, Zhang B. Study of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block to prevent pain syndrome by evaluating ccl2 gene expression after radical mastectomy. Cellular and Molecular Biology. 2022; 67: 264–273.

[32] Kassim DY, Mahmoud HE, Fakhry DM, Mansour MA. Comparative study of dexmedetomidine versus fentanyl as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing radical cystectomy: a prospective randomised study. BMC Anesthesiology. 2022; 22: 340.


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