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Clinical Research Article

Korean J Pain 2020; 33(4): 378-385

Published online October 1, 2020 https://doi.org/10.3344/kjp.2020.33.4.378

Copyright © The Korean Pain Society.

The analgesic efficacy of a single injection of ultrasound-guided retrolaminar paravertebral block for breast surgery: a prospective, randomized, double-blinded study

Boo-Young Hwang1,2 , Eunsoo Kim1,2 , Jae-young Kwon1 , Ji-youn Lee1 , Dowon Lee1 , Eun Ji Park1 , Taewoo Kang3

1Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
2Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
3Department of Busan Cancer Center (Breast Cancer Clinic), Pusan National University Hospital, Busan, Korea

Correspondence to:Eunsoo Kim
Department of Anesthesia and Pain Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea
Tel: +82-51-240-7274
Fax: +82-51-240-7466
E-mail: eunsookim@pusan.ac.kr

Handling Editor: Jee Youn Moon

Received: February 20, 2020; Revised: June 25, 2020; Accepted: July 14, 2020

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery.
Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery.
Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups.
Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

Keywords: Analgesics, Opioid, Anesthetics, Local, Breast Neoplasms, Injections, Spinal, Nerve Block, Pain, Postoperative, Ropivacaine, Ultrasonography, Interventional, Visual Analog Scale