Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.12.008
Brazilian Journal of Anesthesiology
Clinical Information

Ultrasound guided erector spinae plane block for postoperative analgesia after augmentation mammoplasty: case series

Bloqueio do plano eretor da espinha guiado por ultrassom para analgesia pós-operatória em mamoplastia de aumento: série de casos

Baş; ak Altı; parmak; Melike Korkmaz Toker; Ali İ; hsan Uysal; Semra Gümüş; Demirbilek

http://dx.doi.org/10.1016/j.bjane.2018.12.008 Braz J Anesthesiol, vol.69, n3, p.307-310, 2019
PDF English
PDF Português
Downloads: 2
Views: 980

Abstract

Abstract Augmentation mammoplasty is the third most frequently performed esthetic surgical procedure worldwide. Breast augmentation with prosthetic implants requires the insertion of an implant under breast tissue, which causes severe pain due to tissue extension and surgical trauma to separated tissues. In this case series, we present the successful pain management of six patients with ultrasound-guided Erector Spinae Plane block after augmentation mammoplasty. In the operating room, all patients received standard monitoring. While the patients were sitting, the anesthesiologist performed bilateral ultrasound-guided erector spinae plane block at the level of T5. Bupivacaine (0.25%, 20 mL) was injected deep to the erector spinae muscle. Then, induction of anesthesia was performed with propofol, fentanyl, and rocuronium bromide. All patients received intravenous dexketoprofen trometamol for analgesia. The mean operation time was 72.5±6 min and none of the patients received additional fentanyl. The mean pain scores of the patients were 1, 2, 2, and 2 at the postoperative 5th, 30th, 60th and 120th minutes, respectively. At the postoperative 24th hour, the mean Numerical Rating Scale score was 1. The mean intravenous tramadol consumption was 70.8±15.3 mg in the first 24 h. None of the patients had any complications related to erector spinae plane block.

Keywords

Analgesia, Augmentation mammoplasty, Erector spinae plane block, Postoperative pain, Peripheral block

Resumo

Resumo A mamoplastia de aumento é o terceiro procedimento cirúrgico estético mais feito em todo o mundo. A cirurgia com implantes protéticos requer a inserção de um implante sob o tecido mamário, o que causa dor intensa devido à extensão do tecido e trauma cirúrgico aos tecidos separados. Nesta série de casos, apresentamos o manejo bem-sucedido da dor em seis pacientes com bloqueio do plano eretor da espinha guiado por ultrassom (US-ESP) após mamoplastia de aumento. Na sala de cirurgia, todas as pacientes receberam monitoramento padrão. Enquanto as pacientes estavam sentadas, o anestesiologista fez o bloqueio US-ESP bilateral no nível de T5. Bupivacaína (0,25%, 20 mL) foi injetada entre os músculos romboide maior e eretor da espinha. Em seguida, a indução anestésica foi feita com propofol, fentanil e rocurônio. Todas as pacientes receberam dexcetoprofeno trometamol por via venosa para analgesia. O tempo médio de operação foi de 72,5 ± 6 minutos e nenhuma das pacientes recebeu fentanil adicional. Os escores médios de dor das pacientes foram 1, 2, 2 e 2 no 5°, 30°, 60° e 120° minutos de pós-operatório, respectivamente. No 24° dia de pós-operatório, o escore médio da Escala de Avaliação Numérica (NRS) foi 1. O consumo médio de tramadol foi de 40 ± 33,4 mg nas primeiras 24 horas. Nenhuma das pacientes apresentou complicações relacionadas ao bloqueio US-ESP.

Palavras-chave

Analgesia, Mamoplastia de aumento, Bloqueio do plano eretor da espinha, Dor pós-operatória, Bloqueio periférico

References

Kang CM, Kim WJ, Yoon SH. Postoperative pain control by intercostal nerve block after augmentation mammoplasty. Aesthetic Plast Surg. 2017;41:1031-6.

Bakr MA, Mohamed SA, Mohamad MF. Effect of dexmedetomidine added to modified pectoral block on postoperative pain and stress response in patient undergoing modified radical mastectomy. Pain Phys. 2018;21:E87-96.

Wolf O, Clemens MW, Purugganan RV. A prospective, randomized, controlled trial of paravertebral block versus general anesthesia alone for prosthetic breast reconstruction. Plast Reconstr Surg. 2016;137:660e-6e.

Chin KJ, Adhikary S, Sarwani N. The analgesic efficacy of pre-operative bilateral Erector Spinae Plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72:452-60.

Singh S, Chowdhary NK. Erector spinae plane block an effective block for post-operative analgesia in modified radical mastectomy. Indian J Anaesth. 2018;62:148-50.

El-Boghdadly K, Pawa A. The erector spinae plane block: plane and simple. Anaesthesia. 2017;72:434-8.

Sarhadi NS, Dunn JS, Lee FD. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg. 1996;49:156-64.

Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med. 2018;43:567-71.

Ueshima H, Otake H. Limitations of the erector spinae plane (ESP) block for radical mastectomy. J Clin Anesth. 2018;51:97.

Ueshima H. Pneumothorax after the erector spinae plane block. J Clin Anesth. 2018;49:12.

Karaca O, Pınar HU, Arpacı E. The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: a prospective, randomised study. Anaesth Crit Care Pain Med. 2019;38:47-52.

Altıparmak B, Korkmaz Toker M. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: a prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61-5.

5dc569a70e8825d462593254 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections