Use of ultrasound guided single shot costotransverse block (intertransverse process) in breast cancer surgery: a prospective, randomized, assessor blinded, controlled clinical trial

Abstract

Background Ultrasound guided costotransverse block (CTB) is a relatively new “peri-paravertebral” block that has been described recently. It has been previously reported that CTB, administered with a single high-volume injection, provides effective analgesia in breast conserving surgery. In this study we evaluated the effect of CTB when used in breast cancer surgery. Methods Seventy patients due to undergo breast cancer surgery were included in this blinded, prospective, randomized, efficiency study. Patients were randomized into two equal groups (CTB group and control group) using the closed envelope technique. All patients underwent general anesthesia. In addition to standard analgesia methods, patients in group CTB also received CTB block while the remaining (control group) did not. Numeric rating (pain) scores and opioid consumption was compared between the two groups. Results Opioid consumption in all time frames and pain scores at 1st and 3rd hours only were found to be significantly lower in Group CTB when compared to the control group. Conclusions Ultrasound guided CTB improves analgesia quality in breast cancer surgery. Trial registration Clinicaltrials Registration ID: NCT04197206, Registration Date: 13/12/2019.

Insignificant influence of the intertransverse process block for major breast cancer surgery: a randomized, blinded, placebo-controlled, clinical trial

“…The insignificant influence of the ITP block with an absence of any measurable and clinically beneficial effects on postoperative opioid consumption in the current trial was highly unanticipated, contradicts previous findings10–12 16 17 and differs vastly from our initial hypothesis. Remarkably, although non-significant the placebo group had an overall decreased opioid consumption compared with the active group: we have no reason to believe that the blockade should cause exaggerated pain and we regard this, probably, as a chance finding.…”

“…Allegedly, the ITP block is effective in both breast cancer surgery and in video-assisted thoracoscopic surgeries8 9 with multiple-injection presumably advantageous in regard to dermatomal coverage12 in comparison to single injection 10. However, despite evidence that the ITP block is an opioid-sparing modality, the actual saved cumulated opioid quantity in various studies seems clinically inconsequential 11…”

“…Although an abundance of ITP blocks has emerged, compelling evidence of clinical efficacy of ITP blocks remains sparse 8 9. Furthermore, ITP blocks have not been thoroughly investigated in patients undergoing breast cancer surgery in randomized placebo-controlled trials 10–12…”

Comparison between ultrasound-guided multi-injection intertransverse process and thoracic paravertebral blocks for major breast cancer surgery: a randomized non-inferiority trial

“…Our results suggested that the multi-injection ITPB could persistently block the dermatomes of T2–7 and provide effective analgesia for major breast cancer surgery. A recent study demonstrated that a single-injection ITPB at T3–4 using a mixture of 0.5% bupivacaine 15 mL plus 2% lidocaine 10 mL improved analgesic efficacy compared with no block in patients undergoing major breast cancer surgery 22. However, the analgesic improvement appeared to be marginal.…”

Costotransverse block versus costotransverse foramen block: Long way to clarity on the difference in anatomy and techniques

“…[ 3 ] I would like to use the term “costotransverse block” (CTB) for MICB to make it simple and for the correct understanding of the technique per se . The term CTB was used previously by Aygun et al [ 4 ] as they provided a single-shot block, in contrast to the multiple-level injections advocated by Nielsen et al ,[ 5 ] who described this technique first and named it “MICB”. The main purpose of this article is to clarify the difference between the two techniques, namely, the CTB and CTFB.…”