Chakraborty Arunangshu, Agrawal Sanjit, Bose Shiladitya, Ahmed Rosina, Khemka Rakhi
Department of Onco-Anaesthesia, Tata Medical Center, Kolkata 700160, India.
https://orcid.org/0000-0002-0069-700X.
Ecancermedicalscience. 2024 Sep 27;18:1781. doi: 10.3332/ecancer.2024.1781. eCollection 2024.
Mastectomy and breast reconstruction with latissimus dorsi myocutaneous flap (LDF) is a major surgery that covers eight or more dermatomes causing severe pain in the postoperative period.
We evaluated the analgesic effect of a hybrid technique of ultrasound-guided combined thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) in a single needle pass in ten consecutive patients scheduled for mastectomy with LDF reconstruction as a part of a multimodal analgesia regimen.
Prospective observational study.
A tertiary-level cancer hospital in Eastern India. The study was conducted between 01/09/2023 and 20/12/2023.
10 consecutive consenting female patients of age between 18 and 75 years suffering from breast cancer, scheduled for a mastectomy with LDF reconstruction were recruited in this study, excluding patients with body mass index more than 40, coagulopathy or thrombocytopenia, skin conditions such as dermatitis, infection and so on, and known allergy to local anaesthetics (LAs).
The recruited patients received an ultrasound-guided combined thoracic paravertebral and erector spinae (COMPARES) block at the third thoracic (T3) level in a single needle pass, with 10 mL in the TPVB and 30 mL in the ESPB compartment, respectively, in a cephalad to caudad approach before induction of general anaesthesia.
The primary endpoint was pain score at 9:00 am on postoperative day one. Other outcome measures were pain scores at postoperative hours 0 (immediately after awakening from general anaesthesia), 4, 8 and 12, postoperative nausea vomiting, requirement of rescue analgesics and pain score on shoulder movements on postoperative day one.
Median (range) resting pain scores at 0, 4, 8 and 24 hours were 1.5 (0-5), 2.5 (0-4), 2.5 (2-5) and 3 (2-4), and dynamic pain score on shoulder mobilization on postoperative day one morning was 3 (2-6). Only one patient required rescue analgesia.
We found the technique inexpensive and potentially useful, but difficult in obese and short-statured patients due to increased depth and narrowing of the intertransverse space. This technique should be further evaluated in a randomised controlled trial.
This trial was registered with the Clinical Trials Registry of India with the registration number CTRI/2023/08/057119.
乳房切除术及背阔肌肌皮瓣（LDF）乳房重建术是一项大型手术，其覆盖八个或更多皮节，会在术后引发剧痛。
我们评估了超声引导下联合胸椎旁神经阻滞（TPVB）和竖脊肌平面阻滞（ESPB）的混合技术在连续10例计划行LDF重建乳房切除术患者中的镇痛效果，该技术作为多模式镇痛方案的一部分，通过单次进针完成。
前瞻性观察性研究。
印度东部的一家三级癌症医院。研究于2023年9月1日至2023年12月20日进行。
本研究纳入了10例年龄在18至75岁之间、连续同意参与的乳腺癌女性患者，她们计划行LDF重建乳房切除术，排除体重指数超过40、患有凝血病或血小板减少症、患有皮炎、感染等皮肤疾病以及已知对局部麻醉药（LA）过敏的患者。
入选患者在全身麻醉诱导前，采用头端至尾端进针的方式，于第三胸椎（T3）水平进行单次进针的超声引导下联合胸椎旁和竖脊肌（COMPARES）阻滞，TPVB腔隙注入10 mL，ESPB腔隙注入30 mL。
主要终点是术后第1天上午9点的疼痛评分。其他观察指标包括术后0小时（全身麻醉苏醒后即刻）、4小时、8小时和12小时的疼痛评分、术后恶心呕吐、抢救性镇痛药的使用需求以及术后第1天肩部活动时的疼痛评分。
术后0小时、4小时、8小时和24小时的静息疼痛评分中位数（范围）分别为1.5（0 - 5）、2.5（0 - 4）、2.5（2 - 5）和3（2 - 4），术后第1天上午肩部活动时的动态疼痛评分为3（2 - 6）。仅1例患者需要使用抢救性镇痛药。
我们发现该技术成本低廉且可能有用，但对于肥胖和身材矮小的患者来说操作困难，因为横突间间隙深度增加且变窄。该技术应在随机对照试验中进一步评估。
本试验已在印度临床试验注册中心注册，注册号为CTRI/2023/08/057119。
