General anaesthesia versus thoracic paravertebral block for breast surgery: A meta-analysis

Tahiri, Youssef; Tran, De Q.H.; Bouteaud, Jeanne; Xu, Liqin; Lalonde, Donald H.; Luc, Mario; Nikolis, Andreas

doi:10.1016/j.bjps.2011.03.025

Cited by 91 publications

(76 citation statements)

References 26 publications

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“…Nous avons comparé nos résultats avec les publications précédentes dans une méta-analyse. Résultats Comparé au groupe SOA, le groupe PPA a présenté des scores médians (intervalle interquartile) de douleur réduits sur l'EVA (respectivement, 1 [1,3] Conclusion Nos résultats ont été largement concordants avec des études antérieures beaucoup plus petites. Comparativement à l'AG au sévoflurane avec analgésie par opioïdes, l'association d'une analgésie paravertébrale et d'une AG au propofol a fourni des avantages cliniques précoces pour les femmes subissant une chirurgie pour cancer du sein.…”

Section: Résuméunclassified

“…It is hardly surprising that the technique provides excellent analgesia and therefore reduces the need for deep general anesthesia (GA). [1][2][3][4] Nevertheless, the extent to which paravertebral analgesia reduces the requirement for intraoperative volatile anesthetics and postoperative opioid analgesia remains unclear, with current estimates based on single-centre reports with a small sample size.…”

Section: Résumémentioning

confidence: 99%

“…This is the strategy used in nearly all previous studies of paravertebral analgesia for breast surgery. 3 A laryngeal mask was inserted if necessary in patients receiving larger propofol doses. The addition of sevoflurane and/or fentanyl was permitted if insertion of an endotracheal tube was required due to the need for deeper anesthesia.…”

Section: Protocolmentioning

confidence: 99%

See 2 more Smart Citations

Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial

Buggy

Fleischmann

et al. 2014

Can J Anesth/J Can Anesth

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Background The contribution of regional anesthesia with thoracic paravertebral blockade to postoperative analgesia remains unclear. We compared the effect of a combination of paravertebral blockade and propofol general anesthesia (GA) with sevoflurane GA and opioid analgesia on postoperative pain and opioid use for patients undergoing breast cancer surgery. Methods Patients having breast cancer surgery were randomly assigned to paravertebral analgesia with propofol GA (PPA, n = 187) or sevoflurane GA with perioperative opioid analgesia (SOA, n = 199). The PPA and SOA groups were compared for opioid consumption and pain outcomes (on a 0-10 visual analogue scale [VAS]) at two hours postoperatively using superiority and inferiority statistics. We compared our results with previous publications in a meta-analysis. [0,12] mg, respectively, morphine equivalents; median difference -3; 99% CI: -4 to -2). Thus, non-inferiority was detected for all the above outcomes, and superiority tests for each outcome were highly significant in the expected directions (P \ 0.001). Meta-analysis, including the current study, estimated a reduction in worst pain of 2.3 points (95% CI: 1.8 to 2.8) on a 0-10 scale and a 72% reduction (95% CI: 42 to 87) in Conclusion Nos résultats ont été largement concordants avec des études antérieures beaucoup plus petites. Comparativement à l'AG au sévoflurane avec analgésie par opioïdes, l'association d'une analgésie paravertébrale et d'une AG au propofol a fourni des avantages cliniques précoces pour les femmes subissant une chirurgie pour cancer du sein. Cette analyse est une sous-étude d'un essai randomisé multicentrique à double insu sur la récidive cancéreuse (www.ClinicalTrials.gov: n8 NCT00418457).

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confidence: 99%

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Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial

Buggy

Fleischmann

et al. 2014

Can J Anesth/J Can Anesth

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“…28 Pain scores at 1 and 6 hours after surgery were significantly lower in those receiving PVB, and rescue analgesics were less often needed, translating into earlier discharge and greater patient satisfaction. [29][30][31] Postoperative pain control with regional blocks was reportedly superior to systemic analgesia. 32 Pain control in the immediate postoperative period may even have long-term consequences.…”

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confidence: 99%

“…35 Apart from superior pain control, PVB helps also to reduce postoperative nausea and vomiting (PONV), likely a direct result of reduced opiate use. 29 PONV is particularly relevant to breast cancer surgery since patients are mostly female, which in itself is an independent predictor of PONV. 36 Anti-emetics, such as dexamethasone and ondansetron, are the main agents used to manage PONV and are given prophylactically.…”

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Ambulatory surgery for the patient with breast cancer: current perspectives

Pek¹,

Tey²,

Tan³

2016

OAS

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Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefits of better psychological adjustment for the patient, economic savings, and a more efficient utilization of health care resources. The minimal care needed post-discharge also means that the caregiver is not unduly burdened. Unplanned conversions to inpatient admission and readmission rates are low. Wound complications are infrequent and no issues with drain care have been reported. Because the period of postoperative observation is short and monitoring is not as intensive, ambulatory surgery is only suitable for low-risk procedures such as breast cancer surgery and in patients without serious comorbidities, where the likelihood of major perioperative events is low. Optimal management of pain, nausea, and vomiting is essential to ensure a quick recovery and return to normal function. Regional anesthesia such as the thoracic paravertebral block has been employed to improve pain control during the surgery and in the immediate postoperative period. The block provides excellent pain relief and reduces the need for opiates, which also consequently reduces the incidence of nausea and vomiting. The increasing popularity of total intravenous anesthesia with propofol has also helped reduce the incidence of nausea and vomiting in the postoperative period. Ambulatory surgery can be safely carried out in centers where there is a well-designed workflow to ensure proper patient selection, counseling, and education, and where patients and caregivers have easy access to medical services should problems arise after discharge.

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Paravertebral anaesthesia with or without sedation versus general anaesthesia for women undergoing breast cancer surgery

Chhabra

Prabhakar

Subramaniam

et al. 2018

Cochrane Database of Systematic Reviews

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General anaesthesia versus thoracic paravertebral block for breast surgery: A meta-analysis

Cited by 91 publications

References 26 publications

Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial

Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial

Ambulatory surgery for the patient with breast cancer: current perspectives

Paravertebral anaesthesia with or without sedation versus general anaesthesia for women undergoing breast cancer surgery

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