Double-blinded, Placebo-controlled, Prospective Randomized Trial Evaluating the Efficacy of Paravertebral Block with and Without Continuous Paravertebral Block Analgesia in Outpatient Breast Cancer Surgery

Abstract

The current study does not support the routine use of continuous paravertebral catheter anesthesia in patients undergoing operative treatment for breast cancer.

Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study

“…Relatedly, nonsteroidal antiinflammatory agents, gabapentin, and local anesthetic wound infiltration/infusion were not used per the surgeon's preferred standard analgesic regimen, the addition of which may have decreased the differences found between the two treatment groups. [42][43][44] In addition, although the overwhelming number of investigations, including those of the current study, involving breast surgery and paravertebral infusion included the third thoracic level for catheter insertion, [45][46][47][48][49][50][51][52] the optimal level for mastectomy analgesia remains unknown. We did not measure blood levels of nociceptive processing or stress response markers that could have helped elucidate any association of perioperative analgesia with persistent postoperative pain and cancer recurrence.…”

A case series of thoracic paravertebral blocks using a combination of ropivacaine, clonidine, epinephrine, and dexamethasone

“…Preincisional PVB reduces chronic pain by incidence and intensity one year following breast cancer surgery, possibly by reducing the intensity of the acute pain several days postoperatively [9]. Our practice is to place the PVB prior to surgery.…”

“…A randomized prospective study examined if there was any advantage in placing a PVB with a catheter. The study concluded that a catheter conferred no added benefit [9].…”

Pain Management for Ambulatory Surgery: What Is New?

“…In the ambulatory setting of 'simple breast surgery' a continuous paravertebral infusion in addition to single shot blocks, did not improve pain, nausea, or mood scores or hasten return to normal activity [58]. It appears that the low pain scores of breast conserving surgery (\3 on a 0-10 scale) do not warrant ongoing infusions, and these should be reserved for more invasive surgery, e.g., mastectomy with immediate reconstruction [58].…”

“…It appears that the low pain scores of breast conserving surgery (\3 on a 0-10 scale) do not warrant ongoing infusions, and these should be reserved for more invasive surgery, e.g., mastectomy with immediate reconstruction [58].…”