Efficacy Of Thoracic Paravertebral Block Vs Thoracic Epidural Analgesia for Post Operative Analgesia in Patient Undergoing Modified Radical Mastectomy

Abstract

Introduction: Breast cancer is the most common cancer among women and most of them require surgery and surgery is conducted under general anaesthesia which is associated with post operative nausea vomiting, post operative pain and chronic pain. Acute post operative pain is an important risk factor for the development of chronic pain after breast surgery. Therefore, effective postoperative pain management after breast cancer surgery is necessary. Paravertebral block and thoracic epidural analgesia for breast surgery are considered a technique of choice for postoperative analgesia in breast surgery. Aims and objectives: To evaluate postoperative analgesia, incidence of postoperative nausea vomiting, requirement of rescue analgesia and to see hemodynamic changes between paravertebral block and thoracic epidural analgesia. Material and methods: This study comprised of 60 patients of age between 18 to 60 years of ASA grade II and III who were diagnosed case of breast cancer and scheduled for modified radical mastectomy. Patient were divided into 2 groups of 30 patients in each group. Group P received paravertebral block prior to general anaesthesia and Group E received thoracic epidural analgesia and all patients followed up 24 hr postoperatively and compared using VAS score and NRS scale. Result: VAS score of both the group were comparable for group P (mean sum VAS 1.51+/-3.44) and for group E (mean sum VAS 2.05+/- 2.54). Postoperative analgesia was good in both the groups. Group E had significantly higher NRS score (mean sum NRS 4.49+/-4.43) compared to group P (mean sum NRS 0.03+/- 0.18). Group P had more hemodynamic stability as compared to Group E. Conclusion: We conclude that Paravertebral nerve block has the potential to offer equivalent surgical condition and analgesia along with good patient satisfaction as compared to epidural anesthesia but better patient profile and tolerance and fewer postoperative side effects when used for breast surgery.