The effectiveness of paravertebral block among women patients undergoing mastectomy surgery in Tikur Anbessa referral specialized hospital, Addis Ababa, Ethiopia.
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Date
2018-06
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Addis Ababa Universty
Abstract
BACKGROUND: -. Thoracic paravertebral block is analgesic in patient having breast surgery for post-operative pain management. mastectomy patient post operatively suffer pain not only due to surgical site and nerve manipulation but also stress is the main aggravating factor Most studies showed significant reduction in pain intensity and severity for patient whom thoracic paravertebral done when compared placebo group. Paravertebral block has been advocated as useful technique for breast surgery. Most studies show it decrease 95% total consumption of opioid, tramadol and Diclofenac in 24 hour.
Objective: To assess the effectiveness of Para vertebral block for post-operative pain management among women underwent mastectomy surgery at Tikur Anbesa specialized Hospital, Addis Ababa, Ethiopia.
METHOD: Hospital based prospective cohort study conducted on 96 patients underwent mastectomy surgery divide in to exposed group and non-exposed group. Each group contained 48 patients. One group exposed TPVB with 15 ml of 0.25% bupivacaine and the other are not exposed. Manny Whitney test were used to compare median pain score, time to first analgesia request in minutes and total analgesia consumption between groups. Homogeneity of categorical independent variable between two exposure groups was analyzed using Chi Square. Box and whisker plot were used to show a median pain score differences between groups and statistical significance were sated at p value < 0.05 with a power of 80%.
Results: The comparisons of the study at recovery room median (IQR) post-operative VAS score 0(0-3) for exposed group and 4(0-8) for non-exposed group (p=0.002). The median pain score at 3rd, 6th, 12th and 24th hours were also lower in exposed group when compared to non-exposed group with p value of <0.001.The time to first analgesia request in minute were longer (720 minute) in exposed compared to 180 min in non-exposed group (p<0.0001). Total consumption of tramadol, Diclofenac and morphine is significant (p<0.0001) but the incidence of nausea and vomiting is not significant between the group (p=0.836). Manny Whitney test were used for non-distributed and independent t test is for normally distributed data.
Conclusion and recommendation: Thoracic Para-vertebral block done post-operatively lowers pain score, total analgesia consumption and prolong time to first analgesia request. Based on these we recommend use of TPVB with 0.25 bupivacaine is effective post-operative analgesia.
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Keywords
thoracic paravertebral, bupivacaine, mastectomy, post-operative pain.