A Prospective Comparison of Continuous Wound Infiltration with Ropivacaine Versus Single-Injection Paravertebral Block After Modified Radical Mastectomy

Sidiropoulou, Tatiana; Buonomo, Oreste Claudio; Fabbi, Eleonora; Silvi, Maria Beatrice; Kostopanagiotou, Georgia; Sabato, Alessandro; Dauri, Mario

doi:10.1213/ane.0b013e31816152da

Cited by 89 publications

(61 citation statements)

References 24 publications

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“…Sidiropoulou and colleagues in their study on women undergoing modified radical mastectomy with axillary dissection compared preoperative PVB with 20 mL of ropivacaine 0.5% with continuous wound infiltration of ropivacaine 0.5% at a 2 mL/h rate through ON-Q Pain Relief System placed subcutaneously and started at the end of surgery regarding to postoperative pain. They concluded that local anaesthetic infiltration by ON-Q Pain Relief System is comparable to single preoperative injection PVB for postoperative pain [18]. In our study we did not find evidence of a greater effectiveness of ON-Q device compared to PVB in patients who underwent thoracotomy.…”

Section: Citationcontrasting

confidence: 72%

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

Cosmo

Federico²,

Sessa³

et al. 2013

J Anesthe Clinic Res

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Objectives: Thoracotomy is one of the most painful surgical stimuli and inadequate management of postthoracotomy pain is often associated with pulmonary and cardiac complications. The aim of this prospective, randomized, double-blinded study was to compare continuous paravertebral block versus continuous incisional infusion with OnQ Pain Relief System. Methods:Forty eight patients, undergoing thoracotomy for elective lobectomy, were randomized to receive a continuous paravertebral infusion of bupivacaine 0.25% through an elastomeric pump which delivers 0.1 mL/Kg/h (group A) or a continuous incisional infusion of bupivacaine 0.25% at an infusion rate of 4 mL/h with OnQ Pain Relief System (group B). Both infusions were started before wound closure, and continued for 48 postoperative hours. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient-controlled analgesia (PCA). Visual analogue scale at rest (VASr) and when coughing (VASi), rescue patientcontrolled analgesia morphine consumption, hemodynamic, time to ambulation and side-effects were evaluated within 48 h. Results:The two groups were comparable regarding to patients' number and characteristics, type of surgery, time to ambulation and side-effects; postoperative hemodynamic profile was stable in all the patients. Absolute pain scores were low in both groups; patients in group A reported significant lower VASr and VASi values during the postoperative 48 hours compared with group B (p<0.001). Total morphine consumption and PCA requests number were significantly lower in group A than in group B (p= 0.05 and p< 0.01).

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Section: Citationcontrasting

confidence: 72%

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

Cosmo

Federico²,

Sessa³

et al. 2013

J Anesthe Clinic Res

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“…Relatedly, nonsteroidal antiinflammatory agents, gabapentin, and local anesthetic wound infiltration/infusion were not used per the surgeon's preferred standard analgesic regimen, the addition of which may have decreased the differences found between the two treatment groups. [42][43][44] In addition, although the overwhelming number of investigations, including those of the current study, involving breast surgery and paravertebral infusion included the third thoracic level for catheter insertion, [45][46][47][48][49][50][51][52] the optimal level for mastectomy analgesia remains unknown. We did not measure blood levels of nociceptive processing or stress response markers that could have helped elucidate any association of perioperative analgesia with persistent postoperative pain and cancer recurrence.…”

Section: Study Limitationsmentioning

confidence: 91%

Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study

et al. 2014

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“…When compared with direct local anesthetic wound infusion following modified radical mastectomy, singleinjection paravertebral blocks provide superior analgesia and decrease pain-restricted movement during the duration of the ropivacaine 0.5% block [133]. However, following the paravertebral block resolution, these findings were reversed with subjects undergoing local anesthetic infusion directly into their wounds experiencing less pain and pain-restricted movement.…”

Section: Paravertebral Blocks: Compared To Other Analgesic Techniquesmentioning

confidence: 99%

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

Cheng

2016

Pain Med

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Objective. To review the published evidence regarding perioperative analgesic techniques for breast cancer-related surgery.Design. Topical review.Methods. Randomized, controlled trials (RCTs) were selected for inclusion in the review. Also included were large prospective series providing estimates of potential risks and technical reports and small case series demonstrating a new technique or approaches of interest to clinicians.Results. A total of 514 abstracts were reviewed, with 284 studies meeting criteria for full review. The evidence regarding preemptive ketamine, scheduled opioids, perioperative non-steroidal anti-inflammatory drugs (NSAIDs), and intravenous lidocaine is mixed and deserves further investigation. There is strong evidence that both pregabalin and gabapentin provide analgesic benefits following breast surgery. There is minimal and conflicting data from highquality randomized, controlled studies suggesting that directly infiltrating and/or infusing local anesthetic (liposome encapsulated or unencapsulated) into the surgical wound is a reliably effective analgesic. In contrast, there is a plethora of data demonstrating the potent analgesia, opioid sparing, and decreased opioid-related side effects from thoracic epidural infusion and both single-injection and continuous paravertebral nerve blocks (the latter two demonstrating decreased persistent post-surgical pain between 2.5 and 12 months). Techniques with limited-yet promising-data deserving additional investigation include brachial plexus blocks, cervical epidural infusion, interfascial plane blocks, and interpleural blocks.Conclusions. While there are currently multiple promising analgesic techniques for surgical procedures of the breast that deserve further study, the only modalities demonstrated to provide potent, consistent perioperative pain control are thoracic epidural infusion and paravertebral nerve blocks.

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A Prospective Comparison of Continuous Wound Infiltration with Ropivacaine Versus Single-Injection Paravertebral Block After Modified Radical Mastectomy

Abstract: Continuous wound infiltration of local anesthetics is an effective alternative to paravertebral analgesia after mastectomy with axillary dissection.

Cited by 89 publications

References 24 publications

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

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