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Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation

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Abstract

Purpose

Retrospective studies have associated perioperative regional anesthesia/analgesia during mastectomy for breast cancer with a decreased incidence of cancer recurrence. However, to date, no prospective data from a randomized controlled trial have been reported. In a previous study we found that extending a single-injection paravertebral block with a multiple-day perineural local anesthetic infusion improves analgesia. This follow-up study investigates the rates of cancer recurrence for the single-injection and multiple-day infusion treatments.

Methods

Patients undergoing unilateral (n = 24) or bilateral mastectomy (n = 36) were included in the study. All patients had been diagnosed with breast cancer or tumor in situ, except for six patients who were receiving prophylactic bilateral mastectomy and were excluded from analyses. Patients received unilateral or bilateral single-injection thoracic paravertebral block(s) corresponding to their surgical site(s) with ropivacaine and perineural catheter(s). Subsequently, patients were randomized to receive either ropivacaine 0.4% (n = 30) or normal saline (n = 30) via their catheter(s) until catheter removal on postoperative day 3. Cancer recurrence from the date of surgery until at least 2 years post surgery was investigated via chart review.

Results

Five of the 54 (9.2%) patients experienced a cancer recurrence following mastectomy—3 of 26 (11.5%) of the patients with perineural ropivacaine and 2 of 28 (7.1%) of the patients with perineural saline.

Conclusions

This pilot study found no evidence that extending a single-injection paravertebral block with a multi-day perineural local anesthetic infusion decreases the risk of post-mastectomy cancer recurrence. However, due to the small sample size of this investigation, further research is needed to draw definitive conclusions.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA

    Daphna M. Finn

  2. Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA

    Brian M. Ilfeld, Sarah J. Madison, Preetham J. Suresh, Nav Parkash S. Sandhu, Nicholas J. Kormylo, Nisha Malhotra, Vanessa J. Loland, Mark S. Wallace & Anya C. Morgan

  3. Department of Surgery, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA

    Jonathan T. Unkart & Anne M. Wallace

  4. Department of Ophthalmology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA

    Cindy H. Wen

  5. Department of Anesthesiology, Outcomes Research Consortium, Cleveland, OH, USA

    Brian M. Ilfeld

  6. Department of Anesthesiology, Lawrence and Memorial Hospital, New London, CT, USA

    Nisha Malhotra

  7. Department of Anesthesiology, University of Washington, Seattle, WA, USA

    Vanessa J. Loland

Authors
  1. Daphna M. Finn
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  2. Brian M. Ilfeld
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  3. Jonathan T. Unkart
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  4. Sarah J. Madison
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  5. Preetham J. Suresh
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  6. Nav Parkash S. Sandhu
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  7. Nicholas J. Kormylo
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  8. Nisha Malhotra
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  9. Vanessa J. Loland
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  10. Mark S. Wallace
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  11. Cindy H. Wen
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  12. Anya C. Morgan
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  13. Anne M. Wallace
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Corresponding author

Correspondence to Brian M. Ilfeld.

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Finn, D.M., Ilfeld, B.M., Unkart, J.T. et al. Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation. J Anesth 31, 374–379 (2017). https://doi.org/10.1007/s00540-017-2345-z

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  • DOI: https://doi.org/10.1007/s00540-017-2345-z

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