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

Abstract

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).

Are Cure Rates for Breast Cancer Improved by Local and Regional Anesthesia?

“…Lastly, if opioids were administered as often in our LRA as in our GA group, then they could potentially "hide" a finding of better cancer outcomes with LRA because of the possible harmful influence of opioids on immune function and therefore cancer recurrence. However, multiple reports, including our own, indicate that opiates are used less often with LRA compared with patients receiving GA. 19,25,30,31 Since we have previously reported less narcotic use in our LRA patients "in-house," we doubt "overutilization" of narcotics in our LRA group biases our study results.…”

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

“…Three independent metaanalyses provide an estimate of paravertebral block potency and are in agreement, finding a reduction in both average and worst pain scores of approximately 1.7-2.5 points on a 0-10 scale when compared with opioidbased analgesics alone [106,113,114].…”

Comparison of Paravertebral Block by Anatomic Landmark Technique to Ultrasound-Guided Paravertebral Block for Breast Surgery Anesthesia

“…[6][7][8][9][10][11] The use of the block is associated with good perioperative analgesia, reduced need for opioids, and improved quality of recovery, although heterogeneity in results exists. 11,12 Major advantages of PVB anesthesia include preservation of physiological homeostasis and immunity, making it an ideal anesthetic technique for high-risk patients and those undergoing breast cancer surgery.…”