Paravertebral Blocks in Breast Cancer Surgery: Is There a Difference in Postoperative Pain, Nausea, and Vomiting?
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The purpose of this study was to evaluate postoperative pain and postoperative nausea and vomiting (PONV) in patients with paravertebral blocks (PVB) undergoing breast cancer surgery with or without axillary staging.
An Institutional Review Board approved, retrospective chart review from January 2007 to December 2009 was performed at a single institution. Charts were reviewed for type of breast cancer surgery, axillary staging, PVB, PONV, postoperative pain score, dosages of pain medication and antiemetic medication given in the Post Anesthesia Care Unit (PACU), and during the postoperative days (POD). The study population consisted of females with a diagnosis of breast cancer undergoing breast cancer surgery, with or without axillary staging. Patients were excluded if they: had simultaneous myocutaneous tissue flap breast reconstruction, had additional surgical procedures, used continuous delivery postoperative pain medications, had a history of chronic pain, or had a history of chronic antiemetics prior to surgery. All patients received standard perioperative medications per the anesthesia department.
A total of 419 patients underwent breast cancer surgery during the given time period of which 337 patients were able to be included in the study. Of these patients, 241 of the 337 patients had PVB and 96 patients did not have PVB. The mean age was 59.5 years. The mean BMI was 28.7 kg/m2. Also, 45.5% of the patients who had PVB (110) had a mastectomy, while 41.1% of patients in the non-PVB cohort (39) had a mastectomy. In addition, 45 patients with PVB had immediate tissue expander reconstruction and only 14 patients in the non-PVB group. Of patients with PVB, 53.3% (129) had a sentinel lymph node biopsy (SLN) and 33.5% (81) had full axillary dissections. Of patients in the non-PVB, 35.8% (34) had no axillary staging and 44.2% (42) underwent SLN. Also, 229 patients with PVB and 78 patients without PVB had a general anesthetic. Only 3.3% of patients with PVB and 4.2% of patients without PVB had postoperative nausea (P = 0.746). One patient with PVB and no patients without PVB reported emesis in the PACU (P = 1). There was no difference in morphine equivalents (P = 0.234) or in pain scores (P = 0.521) between the 2 groups in the PACU. There was no difference in amount of morphine equivalents given on POD0 (P = 0.8) or POD1 (P = 0.079). The reconstruction patients with PVB used less opioid analgesic on POD1 compared with the non-PVB reconstruction group (P = 0.02).
Patients undergoing breast cancer surgery who have paravertebral blocks have similar postoperative nausea and vomiting and similar postoperative pain scores compared with patients without paravertebral blocks. PVB may have an important role in decreasing postoperative pain and opioid analgesic usage in patients electing to have immediate breast reconstruction with tissue expanders.
- Klein SM, Bergh A, Steele S, Georgiade GS, Greengrass RA, Thoracic paravertebral block for breast surgery. Anesth Analg. 2000;90:1402–5. CrossRef
- Boughey JC, Goravanchi F, Parris RN, Kee SS, Kowalski AM, Frenzel JC, et al. Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery. Am J Surg. 2009;198:720–5. CrossRef
- Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol. 1995;6:453–9.
- Quinn A, Brown J, Wallace P, Asbury A. Studies in postoperative sequelae. nausea and vomiting—still a problem. Anaesthesia. 1994;49:62–5. CrossRef
- Terheggen MA, Wille F, Borel Rinkes IH, Ionescu TI, Knape JT. Paravertebral blockade for minor breast surgery. Anesth Analg. 2002;94:355–9.
- Conveney E, Weltz CR, Greengrass R, Iglehart JD, Leight GS, Steele SM, et al. Use of paravertebral block anesthesia in the surgical management of breast cancer. Ann Surg. 1998;227:496–501. CrossRef
- Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006;105:660–4. CrossRef
- Weltz CR, Greengrass RA, Lyerly HK. Ambulatory surgical management of breast carcinoma using paravertebral block. Ann Surg. 1995;222:19–26. CrossRef
- 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;99:1837–43. CrossRef
- Moller JF, Nikolajsen L, Todt SV, Ronning H, Carlsson PS. Thoracic paravertebral block for breast cancer surgery: a randomized double-blind study. Anesth Analg. 2007;105:1848–51. CrossRef
- Thavaneswaran P, Rudkin E, Cooter R, Moyes D, Maddern G. Paravertebral block for anesthesia: a systematic review. Anesthes Analg. 2010;110:1740–4. CrossRef
- Warltier D. Thoracic paravertebral block. Anesthesiology. 2001;95:771–80. CrossRef
- Paravertebral Blocks in Breast Cancer Surgery: Is There a Difference in Postoperative Pain, Nausea, and Vomiting?
Annals of Surgical Oncology
Volume 19, Issue 2 , pp 548-552
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- 1. Department of Surgery, St John Hospital and Medical Center, Detroit, MI, USA
- 2. St George’s University School of Medicine, Grenada, West Indies
- 3. Department of Anesthesia, St John Hospital and Medical Center, Detroit, MI, USA