Postoperative Pain
Conditions
Keywords
BRILMA block, breast-conserving surgery
Brief summary
Regional analgesia technique in addition to multimodal analgesia in breast-conserving surgery aims to reduce opioid consumption. This study evaluates the postoperative analgesic efficacy of ultrasound-guided BRILMA block in patients undergoing breast conserving surgery.
Detailed description
Breast-conserving surgery has become a standard surgical approach in the management of early-stage breast malignancies. Despite being less invasive than other oncologic procedures, postoperative pain remains a significant concern. In postoperative pain management, the addition of regional analgesia techniques to multimodal approaches aims to reduce opioid consumption. First described in 2013, the Serratus-Intercostal Interfascial Plane block targets the branches of the intercostal nerves at the level of the mid-axillary line, specifically around the fourth rib-an anatomical region referred to by the acronym BRILMA. This regional anesthesia technique has demonstrated efficacy in managing postoperative pain, particularly after breast surgery. In the study, investigators planned to evaluate the postoperative analgesic efficacy of ultrasound-guided BRILMA block via 24-hour morphine consumption in patients undergoing breast conserving surgery.
Interventions
PROCEDUREBRILMA block
20 ml 0.25 % bupivacaine was injected into the fascial plane between the serratus anterior muscle and the external intercostal muscle at T4 level.
OTHERStandard intravenous analgesia.
Standard intravenous analgesia.
Sponsors
Istanbul University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Breast-conserving surgery * ASA I-III
Exclusion criteria
* Patient refusal * Presence of contraindications for regional anesthesia ( bleeding disorder, infection at the injection site, local anesthetic allergy) * Chronic analgesic use * Preoperative breast pain * BMI \>35
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphine consumption | postoperative 24-hour | Amount of morphine consumption |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| number of blocked dermatome | 20. minute after block performance | pinprick test in mid-axillary and mid-claviculary line |
| Duration of block application | up to 15 minutes | time from the insertion of probe to the removal of needle from skin |
| Amount of fentanyl for sedation. [Time Frame: Intraoperative 2-3 hours] | during surgery | Amount fentanyl use during surgery |
| Static and dynamic pain scores assessed with numeric rating scale | postoperative 24 hours | pain scores recorded at 0., 1., 4., 8., 12., 24. hours postoperatively |
| Nausea and vomit | postoperative 24 hours | postoperative nausea and vomiting (0=no, 1= mild nausea, 2= severe nausea or vomiting) |
| Complications | Up to 24 hours | Hematoma, vascular puncture, pneumothorax |
| Patient's satisfaction | Up to 24 hours | Likert scale:1-5 (1: very dissatisfied, 5: very satisfied) |
| Rescue analgesia | postoperative 24 hours | number of patients needed rescue analgesia |
Countries
Turkey (Türkiye)
Outcome results
None listed