Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery

Harkouk, Hakim; Fletcher, Dominique; Martinez, Valéria

doi:10.1136/rapm-2020-102040

Cited by 24 publications

(13 citation statements)

References 38 publications

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“…As previously mentioned, CPSP intensity is often related to the presence of a neuropathic component [3,21]. A systematic review (seven RCTs, N ¼ 2087) found lowquality evidence for a protective effect of PVB against chronic neuropathic pain at 12 months after breast cancer surgery (OR 0.51; 95% CI 0.31-085) [22]. This systematic review included both the RCT of Abdallah et al [23] and the large RCT (N ¼ 2108) of Sessler et al [24].…”

Section: Key Pointsmentioning

confidence: 99%

Use of regional analgesia to prevent the conversion from acute to chronic pain

Geradon¹,

Lavand’homme²

2022

Current Opinion in Anaesthesiology

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Purpose of reviewChronic post-surgical pain (CPSP) prevalence has not changed over the past decades what questions the efficacy of preventive strategies. Regional analgesia is used to control acute pain, but preventive effect on CPSP remains debated. Failures and future application of regional analgesia to prevent transition from acute to chronic pain will be discussed. Recent findingsAfter thoracotomy, perioperative regional analgesia does not seem to prevent CPSP. After breast cancer surgery, paravertebral block might prevent CPSP intensity and impact on daily life up to 12 months, particularly in high catastrophizing patients. In knee arthroplasty, perioperative regional analgesia or preoperative genicular nerve neuroablation do not prevent CPSP, although current studies present several bias. The protective role of effective regional analgesia and early pain relief in trauma patients deserves further studies.

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Section: Key Pointsmentioning

confidence: 99%

Use of regional analgesia to prevent the conversion from acute to chronic pain

Geradon¹,

Lavand’homme²

2022

Current Opinion in Anaesthesiology

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“…Numerous factors have been found to be associated with CPSP after breast cancer surgery in the past decade, including socialdemographic, intraoperative, and postoperative factors (6)(7)(8). Several models to predict CPSP have also been developed, mostly in European breast cancer patients (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Prediction models for chronic postsurgical pain in patients with breast cancer based on machine learning approaches

Sun

Lan

et al. 2023

Front. Oncol.

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PurposeThis study aimed to develop prediction models for chronic postsurgical pain (CPSP) after breast cancer surgery using machine learning approaches and evaluate their performance.MethodsThe study was a secondary analysis based on a high-quality dataset from a randomized controlled trial (NCT00418457), including patients with primary breast cancer undergoing mastectomy. The primary outcome was CPSP at 12 months after surgery, defined as modified Brief Pain Inventory > 0. The dataset was randomly split into a training dataset (90%) and a testing dataset (10%). Variables were selected using recursive feature elimination combined with clinical experience, and potential predictors were then incorporated into three machine learning models, including random forest, gradient boosting decision tree and extreme gradient boosting models for outcome prediction, as well as logistic regression. The performances of these four models were tested and compared.Results1152 patients were finally included, of which 22.1% developed CPSP at 12 months after breast cancer surgery. The 6 leading predictors were higher numerical rating scale within 2 days after surgery, post-menopausal status, urban medical insurance, history of at least one operation, under fentanyl with sevoflurane general anesthesia, and received axillary lymph node dissection. Compared with the multivariable logistic regression model, machine learning models showed better specificity, positive likelihood ratio and positive predictive value, helping to identify high-risk patients more accurately and create opportunities for early clinical intervention.ConclusionsOur study developed prediction models for CPSP after breast cancer surgery based on machine learning approaches, which may help to identify high-risk patients and improve patients’ management after breast cancer.

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“…The paravertebral block is a technique involving the injection of a local anesthetic adjacent to the intervertebral foramina where the spinal nerves exit the thoracic vertebral canal, resulting in ipsilateral segmental sympathetic nerve blockade (18)(19)(20). Paravertebral block is a simple and effective technique for unilateral procedures, with minimal incidence of hypotension and urinary retention (7,21).…”

Section: Introductionmentioning

confidence: 99%

Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study

Fei

Qin²,

An³

et al. 2023

Front. Med.

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BackgroundGeneral anesthesia is used in the majority of patients undergoing percutaneous nephrolithotomy. To reduce the general anesthesia-related risks and complications, this study evaluated the efficacy and safety of the paravertebral block as a novel and alternative anesthetic method for percutaneous nephrolithotomy.MethodsThis was a retrospective study. A total of 198 patients under percutaneous nephrolithotomy were included. Among them, 76 patients received paravertebral block and 122 received general anesthesia. Patients’ characteristics, surgical outcomes, anesthetic outcomes, and perioperative complications and the visual analog scale (VAS) were recorded to evaluate the efficacy and safety of paravertebral block compared with general anesthesia. Intergroup differences of the parameters were analyzed using an independent t-test and χ2-tests appropriate.ResultsSeventy-six patients who underwent paravertebral block completed the surgery successfully, three patients were supplemented with propofol for discomfort during ureteroscopy, and two patients were supplemented with remifentanil for incomplete nerve blockade. Patients who underwent paravertebral block had a higher American Society of Anesthesiologists grade and heart function grade, including patients with contraindications to general anesthesia. Intraoperative and postoperative adverse events and the anesthesia costs were less in patients who underwent paravertebral block. VAS pain scores during the postoperative period in patients who underwent paravertebral block were lower than those in patients who underwent general anesthesia without the use of patient-controlled intravenous analgesia.ConclusionIn this retrospective study, paravertebral block was found to be effective and safe in providing intraoperative anesthesia for percutaneous nephrolithotomy, and had less adverse events and anesthesia costs. Paravertebral block is an attractive alternative anesthesia for patients at increased risk of comorbidities following general or neuraxial anesthesia.

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Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery

Cited by 24 publications

References 38 publications

Use of regional analgesia to prevent the conversion from acute to chronic pain

Use of regional analgesia to prevent the conversion from acute to chronic pain

Prediction models for chronic postsurgical pain in patients with breast cancer based on machine learning approaches

Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study

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