A Prospective, Randomized Comparative Study Evaluating the Analgesic Efficacy and Safety Profile of Thoracic Epidural Block Versus Thoracic Paravertebral Block using a Continuous Infusion of Bupivacaine in Patients Undergoing Elective Major Breast Surgery

Abstract

INTRODUCTION: Breast cancer frequently requires surgical intervention and hence causes pain both physically and psychologically. Inadequate pain management leads to several complications including acute pain, reduction in respiratory effort, impaired lung function and delay in hospital discharge. Hence multiple modalities have been tried for post operative pain relief in breast surgeries. AIM OF THE STUDY: To compare the analgesic efficacy and safety profile of thoracic epidural and thoracic paravertebral block using a continuous infusion of bupivacaine in patients undergoing elective major breast surgery. MATERIALS AND METHODS: 60 patients were randomly allocated into either of the two groups. GROUP P: Thirty patients in this group received 8ml of 0.25% bupivacaine as bolus through thoracic paravertebral block, after the completion of the surgical procedure followed by a continuous infusion of 0.1ml/kg/hr of 0.125 % bupivacaine for 48 hours. GROUP E: Thirty patients in this group received 8ml of 0.25% bupivacaine as bolus through thoracic epidural block, after the completion of the surgical procedure followed by a continuous infusion of 0.1ml/kg/hr of 0.125% bupivacaine for 48 hours. OBSERVED PARAMETERS: The following parameters were compared between the two groups: 1. Post operative visual analogue score, 2. Post operative hemodynamics, 3. Incidence of complications, 4. The need for rescue analgesics. RESULTS: On the course of study, the onset of analgesia, degree of analgesia measured by Visual Analogue Score provided by both the epidural and paravertebral groups was comparable. The failure rates in technique in both the groups were also comparable. The need for rescue analgesics were also comparable in both the groups. It was also found that the incidence of hypotension was more in patients belonging to the thoracic epidural group. CONCLUSION: This study concludes that both thoracic epidural block and thoracic paravertebral block provide comparable post operative analgesia in patients undergoing elective major breast surgery but the haemodynamic stability was better maintained with thoracic paravertebral group compared to thoracic epidural group