Safety and effectiveness of paravertebral block for simple mastectomy: a prospective study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242594Keywords:
General anesthesia, Opioid consumption, Paravertebral block, Postoperative pain, Simple mastectomyAbstract
Background: Paravertebral block (PVB) has emerged as an alternative to general anesthesia (GA) for various surgical procedures, offering potential advantages such as improved postoperative pain control and reduced systemic side effects. Simple mastectomy, a common surgical intervention for breast cancer treatment, involves the removal of breast tissue without axillary lymph node dissection.
Methods: This prospective study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from 1st January 2022 to 30th June 2023. A total of 50 patients undergoing simple mastectomy were randomly assigned.
Results: PVB significantly reduced postoperative VAS scores at 1 hour (2.3±1.1 vs. 4.7±1.3), 6 hours (2.1±0.9 vs. 4.4±1.2), 12 hours (1.9±0.8 vs. 3.8±1.0), and 24 hours (1.7±0.6 vs. 3.5±0.9) (all p<0.001). Opioid consumption was lower in the PVB group (4.8±2.1 mg vs. 12.4±3.2 mg, p<0.001). Incidence of PONV was reduced (16% vs. 48%, p=0.019), hospital stay was shorter (2.3±0.5 days vs. 3.1±0.7 days, p=0.001), and patient satisfaction was higher (4.6±0.5 vs. 3.8±0.7, p=0.003). No significant differences were observed in intraoperative hemodynamic parameters or adverse events.
Conclusions: Paravertebral block provides superior pain management, reduces opioid use and PONV, shortens hospital stays, and improves patient satisfaction compared to GA in simple mastectomy, demonstrating its efficacy and safety in perioperative care.
References
World Health Organization. Breast Cancer: Prevention and Control. Available at: https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/. Accessed July 10, 2024.
Smith J, Johnson M. Evolution of mastectomy techniques. Surg J. 2021;10(3):112-8.
Halsted WS. The results of radical operations for the cure of carcinoma of the breast. Ann Surg. 1907;46(1):1-19.
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-1241.
Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350(24):2441-51.
Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy-a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96(4):418-26.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618-25.
Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg. 2000;90(6):1402-5.
Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesth Analg. 2004;99(6):1837-43.
Greengrass R, O’brien F, Lyerly K, Hardman D, Gleason D, D’Ercole F,, et al. Paravertebral block for breast cancer surgery. Can J Anaesth. 1996;43(8):858-61.
Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012;109(2):144-54.
Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013;111(5):711-20.
Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy-a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96(4):418-426.
Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tayara K, Younes F, et al. Thoracic paravertebral block: influence of the number of injections. Reg Anesth Pain Med. 2006;31(3):196-201.
Cheema S, Richardson J, Mcgurgan P. Factors affecting the spread of bupivacaine in the adult thoracic paravertebral space. Anaesthesia. 2003;58(7):684-711.
Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg. 2009;36(1):170-180.
Kulkarni KR, Pujari VS, Khatavkar SS. Impact of paravertebral block on postoperative analgesia and recovery in breast cancer surgery. J Clin Anesth. 2015;27(4):297-301.
Smith J, Stram M, Loeb D. Efficacy and safety of paravertebral blocks in breast surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2020;271(5):886-96.
Johnson J, Wilson M, Donnelly P. Comparative efficacy of paravertebral vs. general anesthesia for mastectomy: a randomized controlled trial. Br J Anaesth. 2019;123(6).
Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2010;105(6):842-52.
Lee J, Kim D, Lee H. Opioid-sparing effects of paravertebral block compared to general anesthesia in breast cancer surgery: a systematic review and meta-analysis. Korean J Pain. 2019;32(3):147-59.
Centers for Disease Control and Prevention. Understanding the epidemic. Available at: https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed July 10, 2024.
Mohta M, Kalra B, Sethi AK, et al. Comparison of general anesthesia vs. paravertebral block in patients undergoing modified radical mastectomy: a randomized controlled trial. Br J Anaesth. 2020;124(4).
Wong SS, Ng KFJ, Liu J, et al. A comparison of intraoperative hemodynamic stability and postoperative recovery between paravertebral and general anesthesia for breast cancer surgery: a randomized controlled trial. Reg Anesth Pain Med. 2021;46(3):183-9.
