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ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 4  |  Page : 1191-1196

Comparative study between thoracic epidural and ultrasound-guided thoracic paravertebral block in perioperative pain management for mastectomy


Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Correspondence Address:
Eman G Ramadan
Shebeen El-Kom, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_154_18

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Objectives To compare between ultrasound-guided thoracic paravertebral block (PVB) and thoracic epidural block in patients undergoing mastectomy for pain control, intraoperative hemodynamics, and postoperative patient satisfaction. Background Thoracic PVB and thoracic epidural appears promising when combined with general anesthesia in reduction of postoperative pain. Patients and methods Between mid-2016 and December 2017, this prospective clinical study included 60 female patients scheduled for a unilateral mastectomy in Menoufia University Hospitals and divided into two groups, 30 each. Patients in group A were given single shot ultrasound-guided PVB at T4 level using 0.3 ml/kg of 0.5% bupivacaine. Patients in group B were given single shot epidural block at T4 level using 2 ml/segment of 0.5% bupivacaine. Results A total of 60 patients were included, of them, 30 patients received PVB and 30 received thoracic epidural. Heart rate was significantly higher in paravertebral group than in thoracic epidural group (P < 0.001). Mean arterial blood pressure was significantly higher in paravertebral group than in thoracic epidural (P < 0.001). The mean score measured using a seven-point Likert-like verbal rating scale for patient satisfaction in paravertebral group was 6.2 ± 0.85, compared with 4.9 ± 1.03 in epidural group; there was a highly significant statistical difference (P < 0.001). There was no significant statistical difference among the studied groups with respect to fentanyl requirements and postoperative visual analogue scale. Conclusion Ultrasound-guided PVB is an effective technique showing greater hemodynamics stability and pain control compared with epidural analgesia for mastectomy.


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