COMPARISION OF THORACIC EPIDURAL BLOCK VS PARAVERTEBRAL BLOCK IN PATIENTS UNDER GOING BREAST SURGERY

• Author Details:   
• Shikha Soni
• Ankit Soni
• Manjula Bapugol
• Sadik Mohammed
• Rakesh Karnawat
• K. L. Tulsiani

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Objective: Despite advances in medical treatment, surgical intervention is often associated with postoperative pain, nausea, and vomiting. While epidural analgesia is considered the gold standard for post- thoracic surgery pain relief even Paravertebral nerve block (PVB) has the potential to offer equal postoperative pain relief and fewer side effects when used for breast surgery.
Method: We compared thoracic PVB with epidural block in a double-blinded, prospective, randomized study of 60 women scheduled for unilateral breast surgery. Patients were divided into two groups of 30 each, Group E (Thoracic epidural group), Group P (Thoracic paravertebral group), each who received 15ml of 0.5% Ropivacaine either in the thoracic epidural region or thoracic paravertebral region.
Results: Patients receiving epidural showed a fall in mean arterial pressure leading to significant p-value at 10, 20, 30, 40, 50 min, 1hr, 1 hr PO. The fall was soon addressed with fluid bolus and if not responding vasopressors were given in form of 6 mg mephentermine. In Group E 33% (10/30) patients required vasopressors as compared to 0% (0/30) in Group P. The analgesic profile of the two regional technique were similar in both groups. In Group E (20%) patient experienced Nausea and Vomiting which was more than Group P (7%)
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.

Key Words: Ropivacaine, Thoracic epidural, Thoracic paravertebral block, VAS (Visual Analogue Scale), Hemodyanamic complications