2. Assistant Professor, Department of Anaesthesiology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat.
3. Professor and head, Department of Anaesthesiology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat.
4. 2nd Year resident, Department of Anaesthesiology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat.
Background: Postoperative pain plays a significant role in the pathogenesis of postoperative pulmonary complications after upper abdominal and thoracic opera¬tions. Diminishing lung volumes due to acute restrictive pulmonary dysfunction due to pain may result in relative hypoxemia, major atelectasis and pulmonary consolidation. Intrapleural analgesia is one of the method for postoperative analgesia.
Methods and Material: After clearance from Institutional Ethics Committee, 80 patients undergoing modified radical mastectomy were selected and divided into two groups randomly. Group B: Intrapleural block was given with inj. Bupivacaine 0.5% (20 ml) with xylocaine adrenaline 10ml. Group BF: Block was given with Bupivacaine 0.5% (20 ml) with xylocaine adrenaline 10 ml with inj. Fentanyl 1 mcg/kg. Total duration of sensory block and analgesia, intraoperative hemodynamics, postoperative pain score and lung volumes and requirement of rescue analgesics were observed.
Results: Hemodynamic parameters were comparable in both the groups. Onset of sensory block in group BF was faster (15.4±2.26) mins than group B (21.925±2.15) mins. Duration of sensory block was significantly higher in group BF (6.45±1.13) hrs than group B (3.5125±0.51) hrs. Total analgesia was significantly prolonged in group BF (11.3±1.0024 hrs) than group B (7.33±2.0153 hrs). Requirement of rescue analgesic dose in group BF was lower (2.05±0.67) than group B (3.025±0.69) Better preservation and earlier recovery of respiratory volumes noted in group BF.
Conclusions: Intrapleural block given with local anaesthetic and fentanyl had faster onset and longer duration of sensory blockade with better preservation of lung volumes.
Keywords: Intrapleural block, , Modified Radical Mastectomy,, Post operative analgesia., regional block