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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Prospective, randomized comparative study of ultrasound-guided blocking of the l...
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Vol. 66. Issue 3.
Pages 137-143 (March 2019)
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Vol. 66. Issue 3.
Pages 137-143 (March 2019)
Original article
DOI: 10.1016/j.redare.2018.11.009
Prospective, randomized comparative study of ultrasound-guided blocking of the lateral cutaneous branches of the intercostal nerves versus conventional analgesia in non-reconstructive breast surgery
Estudio prospectivo, aleatorizado comparativo entre el bloqueo guiado por ultrasonidos de las ramas cutáneas laterales de los nervios intercostales frente a analgesia convencional en cirugía no reconstructiva de mama
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J. González-García
Corresponding author
, A. González-Bada, J.M. López-Ramos, M.A. Echevarria-Correas, M.B.G. Muñecas-Herreras, L. Aguilera-Celorrio
Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
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Figures (2)
Tables (4)
Table 1. Patient demographics, preoperative baseline status, and surgical variables.
Table 2. NRS pain scores by groups.
Table 3. Need for rescue tramadol.
Table 4. Pain at 1, 3 and 6 months after surgery.
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Abstract
Objective

The objective of this study is to determine whether the accomplishment of an interfascial blockade, the blocking of the cutaneous branches of the intercostals nerves in the axillary line (BRILMA) associated with a multimodal analgesic regimen improves post-operative analgesia and allows saving opioids after non-reconstructive surgery of breast.

Material and methods

A prospective, randomized and simple blind study was conducted on patients that underwent non-reconstructive breast surgery. The patients were randomly assigned to the blocking group, or to the standard post-operative analgesia group (paracetamol and dexketoprofen). The main variables analysed were the pain intensity assessed by the verbal numerical scale and the analgesic rescue needs with tramadol.

Results

Statistically significant differences were observed in the consumption of tramadol during the study period (10.5mg in the BRILMA group, compared to 34.3 in the control group, p=.0001). There were also differences in the pain assessment, with lower values found in the BRILMA group.

Conclusions

In non-reconstructive breast surgery, performing a BRILMA block allows obtaining lower pain scores, which implies less need for rescue analgesics and a significant saving of tramadol in the study period.

Keywords:
Nerve block
Intercostal nerves
Regional anaesthesia
Breast-conserving surgery
Opioids
Ultrasound
Resumen
Objetivo

Nuestro objetivo es evaluar si la realización de un bloqueo interfascial, el bloqueo de las ramas cutáneas de los nervios intercostales en la línea axilar media (BRILMA) asociado a una pauta analgésica multimodal mejora la analgesia postoperatoria y permite ahorrar opioides tras cirugía no reconstructiva de mama.

Material y métodos

Realizamos un estudio aleatorizado y prospectivo simple, donde los pacientes fueron sometidos a cirugía no reconstructiva de mama. Los pacientes fueron asignados aleatoriamente al grupo de realización del bloqueo, o al grupo de analgesia postoperatoria estándar (paracetamol y dexketoprofeno). Las variables principales analizadas fueron la intensidad del dolor evaluada mediante la escala numérica verbal y las necesidades de rescate analgésico con tramadol.

Resultados

Se observaron diferencias estadísticamente significativas en el consumo de tramadol durante el periodo de estudio (10,5mg en el grupo BRILMA, frente a los 34, 3 en el grupo control, p=0,0001). Asimismo también hubo diferencias en la evaluación del dolor con valores más bajos en el grupo BRILMA.

Conclusiones

En cirugía no reconstructiva de mama la realización de un bloqueo BRILMA permite obtener unas puntuaciones de dolor más bajas, lo que implica menor necesidad de rescate y un importante ahorro de tramadol en el periodo.

Palabras clave:
Bloqueo nervioso
Nervios intercostales
Anestesia regional
Cirugía conservadora de mama
Opioides
Ultrasonografía

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