Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.04.007
Brazilian Journal of Anesthesiology
Scientific Article

The effect of thoracic paravertebral block on seroma reduction in breast surgery–a randomized controlled trial: Thoracal paravertebral block for seroma reduction

Efeito do bloqueio paravertebral torácico na redução de seroma em cirurgia de mama–estudo randomizado controlado

Alparslan Kuş, Ufuk H.Yörükoğlu, Can Aksu, Saffet Çınar, Nuh Zafer Cantürk, Yavuz Gürkan

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Abstract

Background
Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked.

Objective
With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery.

Methods
Forty ASA I–II female patients aged 18–65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively.

Results and conclusions
Mean seroma formation at postoperative 24th hour was 112.5 ± 53.3 mL in the control group and 74.5 ± 47.4 mL in the TPVB group (p = 0.022). NRS scores were similar between two groups (p = 0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6 ± 4 mg in the TPBV group, and 16.6 ± 6.9 mg in the control group (p < 0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.

Keywords

Paravertebral block,  Postoperative pain,  Seroma reduction,  Breast cancer

Resumo

Introdução
Observa-se aumento do número de pacientes submetidos à cirurgia por neoplasia mamária. Seroma é a mais frequente complicação pós-operatória que aumenta a morbidade. Há muito tempo, considera-se o Bloqueio Paravertebral Torácico (BPVT) a técnica padrão ouro para o controle da dor pós-operatória. O BPVT provoca, igualmente, o bloqueio da inervação simpática.

Objetivo
Identificar o efeito do BPVT na redução de seroma em pacientes que realizaram mastectomia e dissecção dos linfonodos axilares.

Método
Foram incluídas no estudo 40 pacientes do sexo feminino ASA I–II, entre 18 e 65 anos de idade, submetidas a mastectomia eletiva unilateral com ressecção de linfonodos axilares. As pacientes foram randomizadas em grupo BPVT e grupo controle. As pacientes do grupo BPVT foram submetidas ao BPVT guiado por ultrassom no nível de T1 e 20 mL de bupivacaína 0,25% foram administrados antes da cirurgia. Bomba de infusão IV ACP foi prescrita para todas as pacientes. Na 24a hora pós-operatória foram registradas a quantidade de produção de seroma, o consumo de morfina e a avaliação da dor pela escala de avaliação numérica (NRS–do inglês Numeric Rating Scale).

Resultados
A quantidade média de seroma na 24a hora pós-operatória foi 112,5 ± 53,3 mL no grupo controle e 74,5 ± 47,4 mL no grupo BPVT (p = 0,022). Na 24a hora pós-operatória a pontuação NRS foi semelhante nos dois grupos (p = 0,367), porém o consumo médio de morfina foi 5,6 ± 4 mg no grupo BPVT e 16,6 ± 6,9 mg no grupo controle (p < 0,001).

Conclusões
O BPVT reduz a quantidade de seroma enquanto proporciona analgesia efetiva em pacientes que se submetem a mastectomia e remoção dos linfonodos axilares.

Palavras-chave

Bloqueio paravertebral,  Dor pós-operatória,  Redução de seroma,  Câncer de mama

References

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