Emre Sertaç BİNGÜL, Emıne Aysu SALVIZ, Mert CANBAZ, Mehmet GÜZEL, Erol KOZANOĞLU, Meltem KARADENİZ

REDÜKSİYON MAMOPLASTİ AMELİYATLARINDA TORASİK PARAVERTEBRAL BLOK İLE EREKTOR SPİN PLAN BLOĞUNUN PERİOPERATİF ANALJEZİK SONUÇLARININ KARŞILAŞTIRILMASI: RETROSPEKTİF KOHORT ÇALIŞMA

Amaç: Torasik paravertebral blok (TPVB) ve Erektor spina plan bloğu (ESPB) meme ameliyatlarında en çok tercih edilen rejyonal analjezi tekniklerindendir. Literatürde bu iki bloğun birbirine üstünlüğünü gösteren güvenilir kanıtlar kısıtlıdır. Hipotezimizi TPVB’nin akut postoperatif dönemde daha iyi analjezi sağlayacağı yönünde kurduk. Gereç ve Yöntem: Bu retrospektif kohort çalışmada bilateral redüksiyon mamoplasti uygulanan hastalar genel anestezi öncesinde uygulanmış olan rejyonal tekniğe göre (bilateral TPVB veya ESPB, %0,375 bupivakain ile) gruplandırıldı. Ameliyat öncesi (Blok sonrası 10. dakika, 20. dakika ve 30. dakika) ve ameliyat sonrası 0. dakika, 1. saat, 2. saat, 4. saat, 6. saat, 12. saat, 24. saat ve 48. saatte duyu bloğu oluşmuş dermatom sayısı ve postoperatif ağrı skorları tarandı. İntraoperatif ve postoperatif verilen analjezik miktarı, ağrının ilk ortaya çıkışı süresi, bulantı-kusma (POBK) insidansı, uyku süresi, komplikasyonlar ve hasta/cerrah memnuniyet skorları gibi konfor parametreleri araştırıldı. Bulgular: Toplam 58 hasta tarandı. Postoperatif ilk 2 saat ağrı skorları TPVB grubunda daha düşüktü (p<0,05). TPVB, postoperatif 1. günde daha fazla dermatomu bloke ederken (p<0,05), postoperatif tramadol tüketimi her iki blokta benzerdi (p>0,05). Postoperatif 2. gün parasetamol tüketimi ise TPVB ile daha azdı (p=0,03). Postoperatif 1. gün ilk ağrı süresi ve uyku süresi ESPB ile daha kısaydı (p<0,05). Sonuç: Redüksiyon mamoplasti için torasik paravertebral blok, erektor spina plan bloğundan daha etkili analjezik özellikler göstermektedir. Bununla birlikte, ESPB yeterli analjezi sağlanmasında faydalıdır.

Anahtar Kelimeler:

Torasik paravertebral blok, erektor spina plan bloğu, makromasti, redüksiyon mamoplasti, torasik duvar bloğu, akut ağrı, sinir bloğu, rejyonal anestezi

COMPARISON OF THE PERIOPERATIVE ANALGESIC OUTCOMES OF THORACIC PARAVERTEBRAL BLOCK VERSUS ERECTOR SPINAE PLANE BLOCK IN REDUCTION MAMMAPLASTY SURGERIES: A RETROSPECTIVE COHORT STUDY

Objective: Thoracic paravertebral block (TPVB) and Erector spinae plane block (ESPB) are the most preferred regional analgesia techniques for breast surgeries. However, the literature is still lack of reliable evidence to prove superiority of one over another. We hypothesized that TPVB would provide better pain control for the acute postoperative period. Material and Methods: In this retrospective cohort study, macromastia patients who underwent bilateral reduction mammaplasty surgery were grouped according to the regional technique performed prior to general anesthesia induction that are provided with 0.375% bupivacaine bilaterally (TPVB or ESPB). Presurgery (10th min, 20th min, and 30th min) and postoperative number of dermatomal sensory block, and postoperative pain scores were screened which referred to postoperative 0 minute,1st hour, 2nd hour, 4th hour, 6th hour, 12th hour, 24th hour and 48th hour examination. Intraoperative and postoperative analgesic administration, and comfort parameters such as time-to-first pain, nausea-vomiting (PONV) incidence, sleep duration, complications and patient/surgeon satisfaction scores were also investigated. Results: Total 58 patients were screened. Pain scores were lower in TPVB group for the postoperative first 2 hours (P<0.05). TPVB blocked more dermatomes during postoperative 1st day (P<0.05) whereas postoperative tramadol consumption were similar with both blocks (P>0.05). On the other hand, postoperative 2nd day paracetamol consumption was less with TPVB (P=0.03). Time-to-first pain and sleep duration on the postoperative 1st day was shorter with ESPB (P<0.05). Conclusions: Thoracic paravertebral block represents better analgesic features than erector spinae plane block for reduction mammaplasty. However, ESPB may still be considered to provide favorable analgesia.

Keywords:

Thoracic paravertebral block, erector spinae plane block, macromastia, reduction mammoplasty, thoracic wall block, acute pain, nerve block, regional anesthesia,

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