LUDHIANA E POSTER AWARD ABSTRACTS

Abstract

Background and Aims: Conventionally,surgery for breast carcinoma is done under general anaesthesia(GA).Recently thoracic paravertebral block(TPVB) is gaining popularity as it produces unilateral block and minimal haemodynamic changes.It also facilitates post-op analgesia,early ambulation,and reduces hospital stay. Aim was to evaluate efficacy of single needle TPVB with catheter using 0.5% bupivacaine as a sole anaesthetic approach for Modified radical mastectomy(MRM). Methods: 60 consenting ASA I & II, females aged 30 -60yrs scheduled for modified radical mastectomy were randomly assigned into 2groups: Gr.P(n=30),Gr.G(n=30). Gr.P: TPVB was given using 18G touhy needle.Epidural catheter inserted 2-3cm inside the paravertebral space at T4 level.INJ BUPIVACAINE 0.5% isobaric 20ml injected through catheter.IV infusion of Dexmedetomidine started for sedation. Gr.G: GA with midazolam,fentanyl,propofol and atracurium. Measured parametres were Baseline, Intra-op haemodynamics,induction time,recovery time,fentanyl requirement,average blood loss and post-op pain score by VAS at 0,1/2,1,2,4,8,12,24hrs,duration of analgesia,patient and surgeon satisfaction scores(PSS,SSS),incidence of post-op nausea vomiting(PONV). RESULTS: PARAMETERS Gr.P (n=28) mean±SD Gr.G (n=30) mean±SD P I.TIME (min) 12.25±3.66 6.53±0.94 <0.0001 R.TIME (min) 1.61±0.69 7.23±1.83 <0.00001 INTRA-OP Fentanyl (ug) 9.28±23.52 37.33±36.21 <0.001 Blood Loss (ml) 167.86±45.06 291.67±56 <0.00001 Duration of analgesia (min) 531.43±100.29 130±77.33 <0.00001 SSS 96.96±4.78 97.83±4.09 0.23 PSS 95.36±4.7 95.67±5.21 0.41 PONV 2/28 (7.14%) 16/30 (53.3%) <0.0001 Induction was prolonged in Gr.P(2.25±3.66min),though recovery was faster(1.61±0.69min) in comparison to Gr.G. Also intraoperatively Gr.P required less fentanyl and had less blood loss. Post-op VAS scores,incidence of PONV were significantly more in GA patients. SSS,PSS were similar. Conclusion: TPVB may be a reasonable alternative to GA for MRM as it provides adequate intra and post-op analgesia with minimal adverse events.