This is a case report of a 46 year old female sought to consult due to mass on her right breast. She had previously undergone a modified radical masectomy
Human ; Female ; Middle Aged ; MASTECTOMY, SEGMENTAL ; BREAST NEOPLASMS ; LIDOCAINE ;

Breast surgery is frequently associated with post-operative nausea, vomiting, pain and painful restricted movement. Paravertebral block may be an alternative to general anesthesia for this type of surgery. We studied the efficacy and safety of paravertebral block technique for the operative treatment of breast cancer and compared post-operative pain relief, length of hospital stay, patient satisfaction, incidence of nausea and vomiting in paravertebral block to general anesthesia. Methods: After written informed consent was obtained from 37 female patients due for modified radical mastectomy, 19 women were randomly allocated to receive paravertebral block, while 18 women received general anesthesia. During monitored sedation, paravertebral blocks opposite spinous processes C6-T7 were performed using bupivacaine 0.5 percent (maximum dose = 3 mgs/kg) with epinephrine, 3-4 ml per segment. Results: Post-operative pain score (VAS) at rest, with deep breathing and coughing; requirement for analgesics; and incidence of nausea were lower in the paravertebral group. There was no difference between groups in the mean length of hospital stay post operation to discharge and incidence of vomiting and other side effects. There was greater patient satisfaction in the paravertebral group. Conclusion: Paravertebral block is an effective and safe alternative to general anesthesia with less pain, less nausea and greater patient satisfaction.
Human ; Female ; ANESTHESIA ; ANALGESIA ; ANESTHESIA, GENERAL ; BREAST NEOPLASMS ; PAIN, POSTOPERATIVE

Background:The FLACC (Facial expression, Leg movement, Activity, Cry, Consalability) behavioral pain assessment scale was developed and validated by Merkel and colleagues among American children last 1997 for autepain assessment of children 2 months to 7 years of age. Since then, it has been validated among other nationalities. It is now being used in Scotland, Australia, Canada and Thailland. This study aimed to determine the inter-reter reliability and construct validity of the FLACC on Filipino posoperative pediatric patients. Methods: A total of 106 children less than 5 years of age (1,68+1.46 years) who were admitted in the Philippine General Hospital Post Anesthesia Care Unit (PACU) were included. Those who are operated on an emergency basis, had neurologic impairment, had developmental delay and required menchanical ventilation postoperatively were excluded. Prior to the data collection phase, the PACU nurses were trained to use the FLACC scale using videotapes of postoperative children. Whenever possible, children were silmultaneuosly rated by two idependent ratersdurig their stay in the PACU. Those with FLACC scores>4 were given an intervention and the pain measurement was repeated and reported accordingly. Results: Inter-rater reliability was good to very good with kappa values for the pain behavior items ranging from 0.75 to 0.82. Construct validity ws established by showing a statistically significant reduction (p<0.001) beteen the pre-intervention score and post-intervention score using Wilcoxon signed rank test. Conclusion: The FLACC exhibited bith inter-rater reliability and contruct validity in the measurement of acute postoperative pain in Filipino children less than 5 years old.
Human ; Child Preschool ; Infant ; PAIN MEASUREMENT ; PAIN ; PEDIATRICS ; PAIN, POSTOPERATIVE