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

Ilfeld, Brian M.; Madison, Sarah J.; Suresh, Preetham; Sandhu, Nav Parkash; Kormylo, Nicholas J.; Malhotra, Nisha; Loland, Vanessa J.; Wallace, Mark; Mascha, Edward J.; Xu, Zhengyu; Wen, Cindy; Morgan, Anya C.; Wallace, Anne M.

doi:10.1245/s10434-014-4248-7

Cited by 81 publications

(69 citation statements)

References 59 publications

(72 reference statements)

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“…It remains unknown if the two groups had little pain simply due to non-intervention factors (e.g., surgical technique), or because both treatments decreased chronic pain equivalently. Regardless of the underlying etiology, this study's negative findings do not contradict the three positive RCTs demonstrating that a continuous paravertebral block reduces both the incidence and intensity of persistent post-surgical pain [103,110,200].…”

Section: Persistent Post-surgical (Chronic) Painmentioning

confidence: 45%

“…One RCT provided evidence that a singleinjection paravertebral block with bupivacaine decreases pain scores and opioid requirements within the first 24 postoperative hours [16], as well as the incidence of subsequent severe pain after 1, 6, and 12 months [110]. And three RCTs reported that a 48-72-hour continuous paravertebral nerve block decreased pain (and in some cases pain-related emotional and physical disability) both during the local anesthetic perineural infusion as well as 2.5, 6, and 12 months following surgery [103,110,200]. A single RCT comparing single-injection paravertebral nerve blocks and wound infiltration failed to detect a difference between treatments at 12 months, and unfortunately did not report any pain data prior to the 12-month time point [201].…”

Section: Persistent Post-surgical (Chronic) Painmentioning

confidence: 99%

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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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Section: Persistent Post-surgical (Chronic) Painmentioning

confidence: 45%

Section: Persistent Post-surgical (Chronic) Painmentioning

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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“…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. 9,76,101,103 In summary, the literature supports PVB as an effective perioperative analgesic technique for breast surgery. Paravertebral block can also provide surgical anesthesia and may decrease nausea and vomiting, hospital stay, and chronic postsurgical pain.…”

Section: Paravertebral Blockmentioning

confidence: 96%

Perioperative Breast Analgesia

Woodworth

Ivie

Nelson

et al. 2017

Regional Anesthesia and Pain Medicine

199

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Breast surgery is exceedingly common and may result in significant acute as well as chronic pain. Numerous options exist for the control of perioperative breast pain, including several newly described regional anesthesia techniques, but anesthesiologists have an insufficient understanding of the anatomy of the breast, the anatomic structures disrupted by the various breast surgeries, and the theoretical and experimental evidence supporting the use of the various analgesic options. In this article, we review the anatomy of the breast, common breast surgeries and their potential anatomic sources of pain, and analgesic techniques for managing perioperative pain. We performed a systematic review of the evidence for these analgesic techniques, including intercostal block, epidural administration, paravertebral block, brachial plexus block, and novel peripheral nerve blocks.

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“…They suggested that their study does not support the routine use of continuous paravertebral catheter anesthesia in patients undergoing operative treatment for breast cancer [8]. Conversely, in 2014, Ilfeld et al [4] conducted a similar study and concluded that adding a multiple-day; continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block may result in a lower incidence of pain as well as pain-related physical and emotional dysfunction 1 year after mastectomy.…”

Section: Single Injection or Infusion For Breast Surgerymentioning

confidence: 99%

“…They concluded that even though there was no significant difference in the incidence or relative risk of chronic pain at 3 and 6 months when TPVB was used in conjunction with GA, nevertheless, patients who received TPVBs reported less severe chronic pain, exhibited fewer symptoms and signs of chronic pain, and also experience better physical and mental health-related quality of life [3]. Ilfeld et al [4] also reported that only 14% of those who received TPVBs developed chronic pain as compared with 47% of those who did not.…”

Section: Prevention Of Chronic Painmentioning

confidence: 99%