Preincisional Paravertebral Block Reduces the Prevalence of Chronic Pain After Breast Surgery

Abstract

We reported earlier that preincisional paravertebral block (PVB) provides significant immediate postoperative analgesia after breast cancer surgery. In the same patients (n = 60), a 1-yr follow-up was performed to find out whether PVB could also reduce the prevalence of postoperative chronic pain. The follow-up consisted of a 14-day symptom diary and telephone interviews 1, 6, and 12 mo after surgery. The 14-day consumption of analgesics was similar in the 30 PVB and the 30 control patients. However, 1 mo after surgery, the intensity of motion-related pain was lower (P = 0.005) in the PVB group. Six months after surgery, the prevalence of any pain symptoms (P = 0.029) was lower in the PVB group. Finally, at 12 mo after surgery, in addition to the prevalence of pain symptoms (P = 0.003) and the intensity of motion-related pain (P = 0.003), the intensity of pain at rest (P = 0.011) was lower in the PVB group. These findings were independent of whether or not axillary dissection had been performed. The incidence of neuropathic pain was low (two and three patients in the PVB and control groups, respectively). In addition to providing acute postoperative pain relief, preoperative PVB seems to reduce the prevalence of chronic pain 1 yr after breast cancer surgery.

Postsurgical Pain Syndromes

“…Both found a significantly lower prevalence of chronic pain in women who had the block. One [35] was a follow-up study of 60 women who had participated in an acute perioperative pain study [39]. In this study the prevalence of pain at both 6 months and 12 months was significantly lower among the women who had received a block (17% versus 40% at 6 months, and 7% versus 33% at 12 months) .…”

“…Radiation therapy and chemotherapy following breast surgery will further increase the prevalence of persistent pain [2]. At least one group of researchers has noted a decrease in the incidence of arm pain and symptoms as surgeons have become more careful in the handling of the nerves in the axilla [35]. There are now a number of studies demonstrating that axillary sentinel node biopsy is associated with less persistent pain than a primary axillary dissection.…”

Douleur chronique postchirurgicale : des pistes pour une prévention ?

“…Un faisceau d'arguments milite pour un tel effet préventif : un bloc prolongé de trois à cinq jours, appliqué immédia-tement après l'induction expérimentale d'une douleur neuropathique, a un effet préventif net objectivé sur l'allodynie et l'hyperalgésie mécanique et thermique [63] ; l'adjonction à l'anesthésie générale d'une anesthésie péridurale thoracique peropératoire diminuerait la pré-valence de la DCPC postthoracotomie (études observationnelles ou comparatives) [38,53,60] ; un bloc paravertébral débuté avant anesthésie générale pour mastectomie réduit la gravité des DCPC [26] ; une telle technique est envisageable dans le cadre de la chirurgie thoracique [10], mais non encore testée dans cette situation chirurgicale ; dans une analyse multivariée basée sur des données rétrospectives, l'existence d'une anesthésie périmédullaire (rachianesthésie ou péridurale) a un caractère protecteur sur la survenue de DCPC après hystérectomie [5] ; l'application de pommade anesthésique sur la région opérée pendant les quatre premiers jours postopératoires réduirait l'incidence de DCPC postmastectomie [18].…”

“…Il faut aussi noter qu'une technique « historique » d'analgésie, la cryoneurolyse du nerf intercostal, est plus dangereuse qu'utile [25]. Reste aussi une question : suffit-il de bloquer en peropératoire, comme cela est suggéré par certaines études [26,32], ou vaut-il mieux couvrir les périodes peropératoire et postopératoire [53], ou une couverture postopératoire seule est-elle utile [18,40] ?…”

Report on a case series investigating a neurostimulation device for the treatment of pain and improvement of mobility and function following elbow surgery

“…Recalcitrant cases may require cortisone injections that demonstrate the best conservative treatment for lateral http://dx.doi.org/10.1016/j.arthe.2014. 10.001 2211-7660/© 2014 Elsevier GmbH. All rights reserved.…”