Korean J Pain.  2020 Oct;33(4):378-385. 10.3344/kjp.2020.33.4.378.

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

• Hwang BY
• Kim E
• Kwon Jy
• Lee Jy
• Lee D
• Park EJ
• Kang T

• KMID: 2507143
• DOI: http://doi.org/10.3344/kjp.2020.33.4.378

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.

Keyword

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

Figure

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  Fig. 1 (A) Proper longitudinal position of the curvilinear transducer with skin markings for the retrolaminar block. (B) Ultrasound image demonstrating the relationship of the vertebral lamina to needle placement with spreading local anesthetics during the retrolaminar block. T2: second thoracic vertebra, T3: third thoracic vertebra.

• 

  Fig. 2 Study flow chart with specific causes of study interruptions and dropouts. The flow chart of this study is based on the CONSORT Statement. Group C: retrolaminar injection with saline, Group R: retrolaminar block with local anesthetics, PCA: controlled analgesia.

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  Fig. 3 (A) The visual analogue scale (VAS) of pain intensity during resting was evaluated at 1, 6, 24, and 48 hours after the operation. VAS during resting decreased in both groups as time passed and was higher in group C than group R at 1 hour postoperatively (P = 0.011). (B) VAS of pain intensity during coughing was assessed at 1, 6, 24, and 48 hours after the operation. VAS during resting decreased in both groups as time passed and was higher in group C than group R at 1 hour postoperatively (P = 0.004). Data were expressed as median ± interquartile range. Mann-Whitney U-test was used for a comparison of the two groups at each measuring point, and rank transform for parametric factorial analyses using ANOVA procedures were performed to analyze the interaction between time and group. Group C: retrolaminar injection with saline, Group R: retrolaminar block with local anesthetics. *P < 0.05 compared with group C.

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  Fig. 4 The accumulated intravenous patient-controlled analgesia (IV-PCA) dose was assessed at 1, 6, 24, and 48 hours after the operation. There was no significant difference between the two groups. Data are expressed as mean ± standard deviation. Repeated measures ANOVA was performed to analyze the interaction between time and group.

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