Multiple levels paravertebral block versus morphine patient-controlled analgesia for postoperative analgesia following breast cancer surgery with unilateral lumpectomy, and axillary lymph nodes dissection

Abstract

Background:Postoperative pain after breast cancer surgery is not uncommon. Narcotic based analgesia is commonly used for postoperative pain management. However, the side-effects and complications of systemic narcotics is a significant disadvantage. Different locoregional anesthetic techniques have been tried including, single and multiple levels paravertebral block (PVB), which seems to have a significant reduction in immediate postoperative pain with fewer side-effects. The aim of this study was to compare unilateral multiple level PVB versus morphine patient-controlled analgesia (PCA) for pain relief after breast cancer surgery with unilateral lumpectomy and axillary lymph nodes dissection.Materials and Methods:Forty patients scheduled for breast cancer surgery were randomized to receive either preoperative unilateral multiple injections PVB at five thoracic dermatomes (group P, 20 patients) or postoperative intravenous PCA with morphine (group M, 20 patients) for postoperative pain control. Numerical pain scale, mean arterial pressure, heart rate, Time to first analgesic demand, 24-h morphine consumption side-effects and length of hospital stay were recorded.Results:PVB resulted in a significantly more postoperative analgesia, maintained hemodynamic, more significant reduction in nausea and vomiting, and shorter hospital stay compared with PCA patients.Conclusion:Multiple levels PVB is an effective regional anesthetic technique for postoperative pain management, it provides superior analgesia with less narcotics consumption, and fewer side-effects compared with PCA morphine for patients with breast cancer who undergo unilateral lumpectomy, with axillary lymph nodes dissection.

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.…”

“…The efficacy of paravertebral blocks in breast cancer surgery has been reported in four meta‐analyses including 32 studies . Our literature search identified 21 studies over our search period, nine of which were included in those meta‐analyses . The use of thoracic paravertebral blocks resulted in lower postoperative pain scores (p < 0.001) , lower opioid consumption compared with general anaesthesia (relative risk (RR) 0.23; 95%CI 0.15–0.37) and a lower incidence of postoperative nausea and vomiting (RR 0.27; 95%CI 0.12–0.61) compared with a control group receiving systemic analgesia alone.…”

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

“…Inadvertent vascular puncture in particular has been reported in 13 publications. [98][99][100][101][102][103][104][105][106][107][108][109][110] These were reported across a range of adult and pediatric populations, under anatomic and ultrasound guidance, during single shot and catheter blocks, and with rates in these reports of between one-in-527 102 and one-in-eight. 105 None of these cases resulted in serious bleeding outcomes, despite the presence of therapeutic anticoagulation in two reports.…”

Perioperative Breast Analgesia

“…80 Additional outcomes were reported in several studies. Seven studies reported an improvement in postoperative nausea and vomiting, 73,75,78,83,84,90,92 and 2 reported shortened length of hospital stay. 84,90 In addition, 4 studies (only 2 of which were double-blind) demonstrated an improvement in pain incidence or characteristics at 1 to 12 postoperative months.…”