close

Вход

Забыли?

вход по аккаунту

?

j.jclinane.2017.10.007

код для вставкиСкачать
Journal of Clinical Anesthesia 44 (2018) 1–2
Contents lists available at ScienceDirect
Journal of Clinical Anesthesia
Correspondence
Continuous erector spinae plane block
provides effective perioperative analgesia for
breast reconstruction using tissue expanders:
A report of two cases
Keywords:
Erector spinae plane block
Breast cancer
Breast reconstruction surgery
Expander
Analgesia
To the editor,
Breast reconstruction surgery using tissue expanders is usually
associated with severe, widespread postoperative pain (ranging
from T2–T3 to T6–T7) due to tissue expansion; however, there is
no generally accepted ‘gold standard’ procedure for pain management. It has been reported that regional anesthetic techniques
(paravertebral anesthesia) lead to a significantly lower incidence of
recurrence or metastasis of breast cancer compared to analgesia
achieved by opioid administration perioperatively [1]; regional analgesia may be considered superior to opioid analgesia during and
after surgery for cancer. In this report, we describe two cases in
which continuous erector spinae plane (ESP) block was performed
to provide perioperative analgesia for breast reconstruction using
tissue expanders. In both cases, a written informed consent for publication was obtained.
1. Case 1
A 49-year-old woman (height 155 cm, weight 43 kg) was
scheduled for right total mastectomy, sentinel node biopsy and
breast reconstruction surgery using tissue expanders. After induction of general anesthesia, an ipsilateral, ultrasound-guided ESP
block was performed as follows. The patient was placed in the
left lateral decubitus position and a linear transducer was placed
in a longitudinal orientation approximately 3 cm lateral to the
T5 spinous process. An 18-gauge Tuohy needle was introduced
in-plane and advanced into the interfascial plane deep to the erector spinae muscle. After negative aspiration for blood, 20 mL of
ropivacaine 0.375% was injected and an indwelling catheter was
placed. The catheter infusion was connected to a patient-controlled anesthesia pump that administered ropivacaine 0.2% at
the rate of 8 mL/h with a 3-mL bolus and a 30-minute lockout period. General anesthesia was maintained with propofol 3.0 μg/mL
(target controlled infusion: TCI) and remifentanil 0.1 μg/kg/min,
and the operation was finished uneventfully. A synthetic opioid,
remifentanil, was used during surgery, but none was used
0952-8180/© 2017 Elsevier Inc. All rights reserved.
postoperatively, and 50 mg of loxoprofen sodium was administered at the end of the operation. The patient did not complain
of pain upon recovery from general anesthesia. The patient's numerical rating scale (NRS) was 0, and the area of analgesia, as
assessed by pinprick test, involved the dermatomes T2 to T8 on
post operation days (POD) 1 and 2.
2. Case 2
A 47-year-old woman (height 157 cm, weight 81 kg) was scheduled for left total mastectomy, sentinel node biopsy and breast reconstruction surgery using tissue expanders. After induction of
general anesthesia, the patient was placed in the right lateral
decubitus position and ipsilateral ESP block and catheter insertion
were performed in the same manner as described in Case 1. The
dose of continuous ESP block was the same as that in Case 1. We
maintained general anesthesia with propofol 2.0 μg/mL (TCI) and
remifentanil 0.05 μg/kg/min; 50 mg of loxoprofen sodium was administered at the end of the surgical procedure. The patient did not
complain pain upon regaining consciousness. The patient's NRS
values at rest and on movement were 0 and 2–3 on POD 1 and 2, respectively, and the area of analgesia, as assessed by pinprick test, involved the dermatomes T3 to T7 on both days.
The ultrasound-guided ESP block is a recently developed procedure
for providing extensive thoracic analgesia [2]. The procedure is relatively
easier to perform and noninvasive, compared to thoracic paravertebral
block and thoracic epidural analgesia. In both cases, ESP block provided
effective analgesia without use of longer-acting opioids like fentanyl intraoperatively. Moreover, the area of analgesia was broad on POD 1–2
(T2–T8 and T3–T7 in patients 1 and 2 respectively), and the patients experienced little to no pain at rest. Our experience indicate that continuous ESP block can be considered as a first-line analgesic method for
breast reconstruction surgery using tissue expanders.
Acknowledgements
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
None.
Yuichi Ohgoshi, MD, Staff Anesthesiologist*
Toshiaki Ikeda, MD, Senior Resident
Department of Anesthesiology, International University of Health and
Welfare Mita Hospital, Tokyo, Japan
*Corresponding author at: 1-4-3 Mita, Minato-ku,
Tokyo 108-8329, Japan.
E-mail address: ohgoshi22@gmail.com (Y. Ohgoshi).
2
Correspondence
Kiyoyasu Kurahashi, MD, PhD, Professor
Department of Anesthesiology, International University of Health and
Welfare Mita Hospital, Tokyo, Japan
Department of Anesthesiology and Intensive Care Medicine, International
University of Health and Welfare, School of Medicine, Narita, Japan
1 September 2017
Available online xxxx
https://doi.org/10.1016/j.jclinane.2017.10.007
References
[1] Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology 2006;105:660–4.
[2] Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a
novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;
41:621–7.
Документ
Категория
Без категории
Просмотров
0
Размер файла
186 Кб
Теги
jclinane, 2017, 007
1/--страниц
Пожаловаться на содержимое документа