Comparison of Paravertebral Plane Block for Post-Operative Analgesia in Modified Radical Mastectomy with Intravenous Nalbuphine

Abstract

Objective: To compare the post-operative analgesic efficacy and adverse effect profile of ultrasound-guided paravertebral plane block with intravenous Nalbuphine in patients with breast cancer planned for modified radical mastectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Anesthesia Department Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2022. Methodology: A total of 106 patients diagnosed with breast cancer Stage I and II requiring modified radical mastectomy were included. Comparison of the post-operative analgesic efficacy and adverse effect profile of ultrasound-guided paravertebral plane block and intravenous Nalbuphine were noted. Results: One hundred six patients were included in the study, and divided into the Nalbuphine Group (n=53) and the Paravertebral Block (PVB) Group (n=53). The per-operative Nalbuphine requirement was significantly reduced in the PVBGroup, 2.28±0.37 mg versus 5.30±0.24 mg in the Nalbuphine-Group (p<0.001). Similarly, the time to the first dose of rescue analgesia was significantly prolonged in the PVB Group at 238.32±5.22 minutes versus 37.71±1.72 minutes in the Nalbuphine Group. The mean satisfaction score between both Groups was 4.33±0.64 in the Nalbuphine was 5.69±0.66 and in the PVB Group (p<0.001). Conclusion: We conclude that paravertebral block is superior to intravenous opioids in decreasing the per-operative and postoperative dose of intravenous opioids with a more favourable profile and a decreased incidence of adverse events.

Keywords

• Analgesia
• Modified radical mastectomy
• Nalbuphine
• Paravertebral block