Ultrasound‐guided multiple‐injection costotransverse block for mastectomy and primary reconstructive surgery. A study protocol

Abstract

Background Postoperative pain amelioration following breast cancer surgery is inconsistent. The novel multiple-injection costotransverse block (MICB) mimics the thoracic paravertebral block (TPVB) by possible anaesthetising the ventral rami of the thoracic spinal nerves and the sympathetic trunk. Proof of concept has been determined in a cadaveric study and needs further clinical testing. Methods This double-blinded, randomised, and placebo-controlled study investigates the efficacy of the ultrasound-guided (USG) MICB vs. placebo in 36 patients undergoing unilateral mastectomy and primary subpectoral reconstruction (UMPR) surgery. Oral preoperative medicine is standardised for all patients. Active group is preoperatively administered MICB with three injections of each 10ml of Ropivacaine 5mg/ml. Placebo group is preoperatively administered three injections of each 10ml of saline 0.9%. Standard general anaesthesia (GA) is induced and 30 minutes before emergence 0.2 μg/kg total body weight Sufentanil IV, 1 gram of paracetamol IV, and 4 mg ondansetron IV (postoperative nausea and vomiting, PONV, prophylaxis) will be administered. All patients are provided a patient-controlled analgesia (PCA) pump with morphine. The primary aim is total morphine consumption in the first 24 postoperative hours. Secondary aims are pain intensity, duration of block, patient satisfaction, side effects, time to ambulation, time to discharge, and quality of recovery. Discussion Recruitment began in November 2019 and is expected to finish ultimo 2021. Results are expected to be published in an international peer-reviewed medical journal. The results will hopefully provide a substantial contribution to the knowledge of these new “intertransverse process blocks” providing regional anaesthesia of the thoracic wall.