Single‐injection paravertebral block compared to general anaesthesia in breast surgery

Abstract

Single-injection paravertebral block at the level of T4 represents a suitable alternative to general anaesthesia in women undergoing breast surgery.

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

“…15 As might be expected, previous small studies generally overestimated treatment effect, with some reporting differences exceeding three points on an 11-point scale. 24 Combining all studies, the overall pain benefit was a reduction by more than 2, an amount which was highly statistically significant but probably also reflects a clinically important reduction in discomfort.…”

“…4 and 5. For worst pain score in the immediate two postoperative hours, the recent relevant meta-analysis 23 contained five eligible trials [24][25][26][27][28] evaluating paravertebral anesthesia as a single technique vs GA and five eligible trials 14,15,[29][30][31] evaluating the combination of paravertebral analgesia and GA vs GA alone. One additional recent trial 32 was identified and included in our meta-analysis along with our current results.…”

“…14,15,[24][25][26][27][28][29][30][31][32] Only five published trials 15,25,29,32,33 with only 262 patients in total evaluated actual opioid consumption in the immediate two postoperative hours in patients randomized to paravertebral analgesia (with or without concomitant GA) vs GA alone. Our results are generally consistent with previous reports and show that patients given paravertebral analgesia had less immediate postoperative pain and required fewer morphine sulphate equivalents.…”

“…It is not surprising that paravertebral blocks are analgesic and reduce opioid use; however, the largest previous study on immediate postoperative pain included only 86 patients 14,24 and the largest study on opioid sparing included only 64 patients. 24 Furthermore, all previous studies were single-centre.…”

“…24 Furthermore, all previous studies were single-centre. Therefore, considerable uncertainty remained over the magnitude of the paravertebral effect and the extent to which it was generalizable.…”