Award Papers / Dr Kop's Award
tebral Block for Post Operative Analgesia for Breast Cancer Surgery: A Prospective, Double Blinded , Randomised Controlled Trial to Compare the Efficacy of 0.375% Levobupivacaine versus 0.25% Levobupivacaine.
Background :Levobupivacaine is a pure S(-) isomer of bupivacaine, newly introduced in the market . There is lacunae in literature regarding the effective concentration for the use of this drug for nerve blocks. Hence we tried to compare the analgesic efficacy of 0.375% levobupivacaine and 0.25% levobupivacaine when used in Ultrasound guided Thoracic Paravertebral Block (TPVB)in terms of postoperative pain scores in patients undergoing breast cancer surgeries, in terms of patient satisfaction and total opioid consumption postoperatively.
Methods : 50 ASA I and II patients scheduled for modified radical mastectomy were randomly assigned to receive USG guided TPVB with 0.375% levobup (group I, n=25) or 0.25% levobup ( group II, n=25 ). The block was administered prior to induction of GA, using the same technique and volume (25ml) for both the groups. Postop pain was rated at 1h, 2h, 4h, 6h, 12h, 24h using Numeric Rating Scale (NRS). Cumulative opioid analgesic consumption and adverse effects were recorded.
Result : Group I and II did not differ significantly in their pain score at 1h , 2h and 4h but Group I had significantly less pain scores and fentanyl consumption (p=0.000) than Group II at 6h , 12h, 24h. However, Group I had significantly higher fall in blood pressure (SBP, p <0.01 )from the baseline values as measured 10 minutes after implementation of the block.
conclusion : When used in TPVB ,0.375% levobup is more effective than 0.25% levobup in reducing postoperative pain associated with breast cancer surgery. However, hypotension occurring immediately after the block using 0.375% levobup may require vasopressor more frequently when compared to 0.25% levobup.
Levobupivacaine is a pure S(-) isomer of bupivacaine, newly introduced in the market . There is lacunae in literature regarding the effective concentration for the use of this drug for nerve blocks. Hence we tried to compare the analgesic efficacy of 0.375% levobupivacaine and 0.25% levobupivacaine when used in Ultrasound guided Thoracic Paravertebral Block (TPVB)in terms of postoperative pain scores in patients undergoing breast cancer surgeries, in terms of patient satisfaction and total opioid consumption postoperatively.
Methods : 50 ASA I and II patients scheduled for modified radical mastectomy were randomly assigned to receive USG guided TPVB with 0.375% levobup (group I, n=25) or 0.25% levobup ( group II, n=25 ). The block was administered prior to induction of GA, using the same technique and volume (25ml) for both the groups. Postop pain was rated at 1h, 2h, 4h, 6h, 12h, 24h using Numeric Rating Scale (NRS). Cumulative opioid analgesic consumption and adverse effects were recorded. Result :Group I and II did not differ significantly in their pain score at 1h , 2h and 4h but Group I had significantly less pain scores and fentanyl consumption (p=0.000) than Group II at 6h , 12h, 24h. However, Group I had significantly higher fall in blood pressure (SBP, p <0.01 )from the baseline values as measured 10 minutes after implementation of the block.
conclusion :When used in TPVB ,0.375% levobup is more effective than 0.25% levobup in reducing postoperative pain associated with breast cancer surgery. However, hypotension occurring immediately after the block using 0.375% levobup may require vasopressor more frequently when compared to 0.25% levobup.