Effectiveness of Preoperative Eutectic Mixture of Local Anaesthetic [EMLA] Application and Postoperative Wound Infiltration of Ropivacaine in Patients Undergoing Modified Radical Mastectomy [MRM]: A Randomised Single Blind trial

Abstract

Original Article Effectiveness of Preoperative Eutectic Mixture of Local Anaesthetic [EMLA] Application and Postoperative Wound Infiltration of Ropivacaine in Patients Undergoing Modified Radical Mastectomy [MRM]: A Randomised Single Blind trial Authors Dr Kurian Cherian, Dr Hereen Antony*, Dr Rachel Cherian Koshy Dept. of Anaesthesiology, Regional Cancer Centre, Tivandum, India *Corresponding Author Dr Hereen Antony Dept. of Anaesthesiology, Govt. Medical College, Tivandum 695011, India Abstract Aims: To assess analgesic efficacy of preoperative EMLA cream and postoperative wound infiltration with ropivacaine in modified radical mastectomy. Method: This is a prospective randomised single blind trial done in ASA-PS 1 and 2 for unilateral MRM aged between 18-60 years. 60 patients are randomised into four groups. First group, preoperatively EMLA cream is applied over the incision. In second group, preoperative EMLA cream with postoperative infiltration with ropivacaine. Third group, only postoperative wound infiltration with ropivacaine. In the fourth group no such interventions. All patients are operated under general anaesthesia. Intraoperatively heart rate variability (HRV) and blood pressure variability (BPV) and postoperatively VAS at rest and movement, degree of arm movement, opioid requirement are noted to assess analgesic efficacy. Statistical analyses is performed by using a statistical software package SPSS, version 20.0 Results: Time to the initial dose of paracetamol and rescue fentanyl dose requirement is significantly lower in groups 2 and 3. HRV and BPV at the time of incision was more in group 3 and 4, so also the intra-operative analgesia. VAS at rest, at 0 hour, at discharge and drain removal was significantly low with group 2 and 3.Similarly VAS on movement, significantly reduced in group 2 and 3 at the time of discharge and drain removal. There was significant increase in degree of arm movement in group 2 and 3. Conclusion: Our study showed postoperative wound infiltration with ropivacaine provided superior analgesia and preoperative EMLA favourable intraoperative hemodynamics.