Background & Aims
Modified radical mastectomy (MRM) is associated with significant post operative pain and leading to prolongation of hospital stay. Pain is considered as an important vital sign and has been equated with quality control of health system . Opioid free/sparing anaesthesia (OFA)/(OSA) has gained popularity nowadays for perioperative analgesia compared to that of an opioid, a lower incidence of nausea and vomiting, early postoperative recovery and better patient satisfaction. There is paucity of literature so, we planned this study to evaluate the opioid sparing effect of multimodal analgesia using costotransverse block (CTB) in patients undergoing MRM surgery
The aim of this study is to compare the effect multimodal opioid sparing anaesthesia using ultrasound guided costotransverse block (CTB) with standard general anaesthesia practice (control group) for postoperative analgesia and quality of postoperative recovery after modified radical mastectomy.
Methods
After approval from ethics committee, this single centre, prospective, randomized controlled study was conducted in tertiary care hospital. Total 66 patients of ASA grade I,II and III, aged 25 to 65 years were enrolled. After informed consent, patients were randomized in two groups. Group A patients received opioid based anaesthesia as per standard practice, Group B patients received Costo-Transverse Block (CTB) with 0.5%, 15 ml ropivacaine at T3 or 4 level unilaterally on the operative side. In opioid sparing group, after CTB block, lignocaine @1.5 mg/kg bolus during induction followed by infusion 2mg/ kg was started. Mgso4 at 30mg/kg was given. Dexmedetomidine infusion given after induction @ 0.5mcg/kg/hr and stopped at end of skin closure.
Amount of fentanyl consumption for 24 hours postoperatively, time for first rescue analgesia, pain scores, total dose of intraoperative fentanyl used as rescue along with the quality of post-operative recovery were compared in both the groups.
Results
Patients in opioid sparing group had significantly better pain scores ( Numerical rating pain score) both at rest and movement when compared to control group. Total amount of fentanyl consumption was significantly less in opioid sparing group. Time for first rescue analgesia was less in opioid sparing groups, these patients asked for rescue analgesia earlier but overall requirement was significantly less when compared to control group. Quality of postoperative recovery by quality of recovery 15 score, was significantly better in opioid sparing group ( p value <0.001).
Conclusions
Opioid free anaesthesia is gaining popularity for offering equivalent perioperative analgesia compared to that of an opioid, early postoperative recovery and better patient satisfaction. Literature is scarce on opioid sparing technique especially for perioperative period in cancer patients. It may have preventive benefit on probable perioperative immunosuppression by opioids. In this study, patients in opioid sparing anaesthesia group had better pain scores and postoperative recovery profile. Multimodal opioid sparing anaesthesia using costotransverse block can be considered as a potential alternative for conventional opioid based anaesthesia. Multicentric randomised control trial with large sample size may be needed to further establish our results.
References
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Presenting Author
Priyanka Sethi
Poster Authors
Priyanka Sethi
MBBS, MD,DNB,MAMS,MNAMS
AIIMS, Jodhpur
Lead Author
Dr Banish Tm
MBBS
AIIMS, Jodhpur
Lead Author
Dr Pradeep Kumar Bhatia
MBBS
AIIMS, Jodhpur
Lead Author
Dr Manbir Kaur
MBBS
AIIMS, Jodhpur
Lead Author
Dr. Kamlesh Kumari
MBBS
AIIMS, Jodhpur
Lead Author
Dr Nivedita Sharma
MBBS
AIIMS,Jodhpur
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Acute Pain and Nociceptive Pain