Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy

Abstract

Background:Paravertebral and inter pleural blocks (IPB) reduce post-operative pain and decrease the effect of post-operative pain on lung functions after breast surgery. This study was designed to determine their effect on lung functions and post-operative pain in patients undergoing modified radical mastectomy.Materials and Methods:A total of 120 American Society of Anesthesiologists physical status 1 and 2 patients scheduled to undergo breast surgery were randomly allocated to receive IPB (Group IPB, n = 60) or paravertebral block (PVB) (Group PVB, n = 60) with 20 ml of 0.5% bupivacaine pre-operatively. A standard protocol was used to provide general anesthesia. Lung function tests, visual analog scale (VAS) for pain at rest and movement, analgesic consumption were recorded everyday post-operatively until discharge.Results:Lung functions decreased on 1st post-operative day and returned to baseline value by 4th post-operative day in both groups. VAS was similar in both groups. There was no significant difference in the consumption of opioids and diclofenac in both groups. Complete block was achieved in 48 patients (80%) in paravertebral group and 42 patients (70%) in inter pleural group.Conclusion:To conclude, lung functions are well-preserved in patients undergoing modified radical mastectomy under general anesthesia supplemented with paravertebral or IPB. IPB is as effective as PVB for post-operative pain relief. PVB has the added advantage of achieving a more complete block.

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

“…The time required to perform a single‐injection paravertebral block was shorter compared with the multiple‐injection group (5 min vs. 10 min; median difference 4 min; 95%CI ‐6 to ‐3 min; p < 0.001) . Ultrasound guidance was used to perform paravertebral injections or catheter positioning in eight studies , whereas 16 other studies did not use ultrasound . The results were not different depending on the use of ultrasound guidance or not.…”

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

“…Local anesthetic is deposited between the parietal and visceral pleura [158][159][160], where it then diffuses to the subpleural space and the intercostal nerves [159][160][161]. In one RCT comparing single-injection interpleural and single-level paravertebral blocks (both bupivacaine 0.5%) for patients undergoing mastectomy, pain scores and analgesic consumption were similar for both interventions [161]. Both treatment groups also exhibited decreased lung functions on the first postoperative day, which improved to near-normal levels by the second postoperative day.…”

Pectoral Nerves I and II Blocks in Multimodal Analgesia for Breast Cancer Surgery

“…10 Thoracic epidural block, thoracic paravertebral block (TPVB), interpleural block, intercostal nerve block, interscalene block, and wound infiltration have all been used in anesthesia and/or analgesia in breast cancer surgery. [11][12][13][14][15][16] Thoracic paravertebral block has been shown to provide superior analgesia, and there is some evidence suggesting decreased cancer recurrence rates with the use of TPVB. 17,18 Nonetheless, not all anesthesiologists feel comfortable using such invasive techniques in breast cancer surgery.…”