Author(s): Vinod Kumar V. S, Kiran Chand N, Mallanna B. P, Srinivasalu D
BACKGROUND: Paravertebral block is an established analgesic technique for pain after breast surgeries. Hyaluronidase, when combined with local anaesthetic may promote better quality of analgesia when given in the single injection technique. We aimed to compare efficacy of Ropivacaine alone or Ropivacaine with Hyaluronidase for single level injection thoracic paravertebral block in unilateral breast surgeries.
METHODS: This prospective controlled study was conducted after institutional ethical committee approval and patient consent in 100 female patients belonging to ASA I and II physical status, posted for elective unilateral breast surgeries. Patients were randomized to two groups of 50 each, to receive ultrasound guided thoracic paravertebral block at T4-T5 level in lateral position; Group RS to receive Ropivacaine (0.75%) 19 ml and Normal saline, 1 ml and Group RH to receive Ropivacaine (0.75%) 19 ml and Hyaluronidase, 1 ml (1500 IU). Standard general anaesthesia protocol was followed with endotracheal intubation. Patients were assessed intraoperatively and post-operatively at 15 min, 30 min, hourly for first two hours and at 4, 6, 12, and 24 h after extubation. Sample size was based on assumption of 20% improvement in quality of blockade in group RH. This calculation assumed the use of student’s test, type Ι error of 0.05, and a power of 80%. Postoperative pain was assessed using Visual Analog Scale (VAS) at rest and at coughing. Haemodynamics, oxygen saturation, peak expiratory flow rate, the dose of rescue analgesics were assessed. Duration of analgesia and quality of analgesia was noted along with adverse effects if any.
RESULTS :All patients were comparable with baseline characteristics. The time for first rescue analgesic and total tramadol consumption in 24 hours were comparable between the groups. The mean VAS scores were less in the RH group compared to RS group between 4 to 24-hour period though not significant statistically.
CONCLUSIONS:The overall duration of analgesia and consumption of tramadol were equal in both the groups, but the mean VAS scores were less in the RH group compared to RS group between 4 to 24 hour period.