Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis

Sheckter, Clifford C.; Tucker, Austin; Watzker, A.; Ottino, Kevin; Zammert, Martin; Padula, William V.

doi:10.1007/s10549-017-4371-9

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…paracetamol, NSAIDs or COX‐2 selective inhibitors) in a fully implemented multimodal analgesia programme. Not surprisingly, a cost effectiveness study reported higher costs of continuous paravertebral block ; however, these costs would be offset by the reduced duration of hospital stay . Interfascial plane blocks also improve postoperative analgesia with lower pain scores and opioid consumption than general anaesthesia alone.…”

Section: Discussionmentioning

confidence: 99%

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Summary Analgesic protocols used to treat pain after breast surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological breast surgery. A systematic review using preferred reporting items for systematic reviews and meta‐analysis guidance with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty‐nine studies were found, of which 53 randomised controlled trials and nine meta‐analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra‐operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non‐steroidal anti‐inflammatory drugs) administered pre‐operatively or intra‐operatively and continued postoperatively. In addition, pre‐operative gabapentin and dexamethasone are also recommended. In major breast surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.

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Section: Discussionmentioning

confidence: 99%

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…There are some local or regional nerve blocks in breast cancer performed as core components of multimodal analgesia and enhanced recovery after surgery (ERAS) ( 12 ), including thoracic epidural ( 13 ), interscalene brachial plexus ( 14 ), paravertebral ( 15 ), pectoral nerve blocks ( 16 , 17 ), and erector spinae plane block ( 18 ). Ultrasound-guided serratus anterior plane block (SAPB) is a new analgesic technique applied to the clinic proposed by Blanco ( 19 ); it is a block in which local anesthetic is deposited within an interfascial plane either superficial or deep into the serratus anterior muscle at the mid-axillary line ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of Ultrasound-Guided Deep Serratus Anterior Plane Block Combined With Dexmedetomidine as an Adjuvant to Ropivacaine Inpatient Quality of Recovery Scores Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial

Kang

et al. 2022

Front. Oncol.

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BackgroundBreast cancer has overtaken lung cancer as the most commonly diagnosed malignancy and is the leading cause of cancer-related death in women. Surgery is the only possible cure for breast cancer, and the incidence of acute postoperative pain (APP) is high in breast surgery. Previous reports suggested that ultrasound-guided deep serratus anterior plane block (dSAPB) provided effective blockade to relieve pain after modified radical mastectomy for breast cancer. In fact, despite the long-acting local anesthetic agents used, the patient’s pain cannot completely be eliminated due to the short duration of anesthesia. Dexmedetomidine as an adjunct to local anesthetics can prolong peripheral nerve block duration. However, no study has investigated the role of dSAPB with dexmedetomidine in the quality of recovery scores undergoing modified radical mastectomy. Thus, this study was conducted aiming at this aspect.Material and MethodsThis single-center, double-blind, randomized clinical trial was conducted at Bethune International Peace Hospital. A total of 88 participants of elective modified radical mastectomy were enrolled from May and November 2021. Ultrasound-guided dSAPB combined with 30 ml of 0.375% ropivacaine or 30 ml of 0.375% ropivacaine with dexmedetomidine (1 μg/kg) was administrated before anesthesia at the fourth to fifth ribs of the axillary midline. The primary outcome was quality of recovery, measured 24 h postoperatively using the QoR-15. Secondary outcomes were the Visual Analogue Scale (VAS) scores at rest and movement at 1, 6, 12, 24, and 48 h after surgery, 48 h sufentanil consumption postoperatively, the incidence of postoperative nausea and vomiting (PONV), length of post-anesthesia care unit (PACU) stay, dizziness, delirium, SAPB-related adverse events, and patient’s satisfaction with pain management.ResultsAmong the 88 participants, 8 did not meet the inclusion criteria; the other 80 were randomized to receive dSAPB combined with ropivacaine (Group R, N=40) and dSAPB combined with ropivacaine plus DEX (Group RD, N=40), of which a total of 7 (4 in Group R and 3 in Group RD) were excluded due to protocol deviation. Eventually,73 participants (36 in Group R and 37 in Group RD) were included for final analysis, with age (SD, years, 54.08[6.28] vs. 54.62[7.44], p=0.740), body mass index (BMI) (SD, 27.96[1.67] vs. 27.57[2.38], p=0.428), and median preoperative global QoR-15 score (interquartile range (IQR), 127[123.25–131] vs. 126[121–130], p=0.662). The median postoperative global QoR-15 score (IQR, 107[103–112] vs. 109.5[107–114], p=0.016), VAS score at rest at 12th hour (IQR, 1[1–2] vs. 1[1–2], p=0.033), VAS score in movement at 12th hour (IQR, 2[1–3] vs. 2[1–3], p=0.014) and at 24th hour (IQR, 3[2–3] vs. 3[2–3], p=0.040), and median sufentanil rescues consumption (IQR, 14[12–17 vs. 14[12–15], p=0.022] of Group RD were significantly lower than those of the Group R. Patient satisfaction score (SD, 8.28[0.70] vs. 8.62[0.59], p=0.024) of Group RD were significantly higher than those of the Group R.ConclusionThe ultrasound-guided dSAPB combined with dexmedetomidine plus ropivacaine may improve the QoR-15 in patients undergoing modified radical mastectomy and indicates that it may be a useful intervention to aid recovery following breast cancer surgery. Furthermore, participants in the ropivacaine with DEX group met the superior pain relief in the early postoperative period, reduced postoperative cumulative opioid consumption, increased patient satisfaction, and no increase in the incidence of complications.

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“…The advantage of using a cost‐utility approach is that there are a range of acceptable values for the incremental cost per QALY gained, termed the incremental cost‐effectiveness ratio, which enables fair comparisons for treatments regardless of the disease or problem it is intended to treat (Shiroiwa et al., ). An alternative approach, which has been used to calculate the cost‐effectiveness of interventions intended to improve outcomes relevant to patient comfort previously, is the willingness to pay method (Offodile et al., ; Pritchard et al., ). Using this method, FAW could be considered cost‐effective for procedures performed with sedation in a cardiac catheterisation laboratory if the extra cost of an incremental gain in thermal comfort is less than the decision maker's willingness to pay for it.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of forced air warming during sedation in the cardiac catheterisation laboratory

Conway

Duff

Sutherland

2018

Journal of Advanced Nursing

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Forced air warming could be considered cost-effective for procedures performed with sedation in a cardiac catheterisation laboratory if the extra cost of an incremental gain in thermal comfort is less than the decision maker's willingness to pay for it. Therefore, those responsible for decision-making regarding use of FAW in the cardiac catheterisation laboratory can use results of our model to decide if it represents good value for their organisation.

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Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis

Abstract: Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

Cited by 12 publications

References 20 publications

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

Impact of Ultrasound-Guided Deep Serratus Anterior Plane Block Combined With Dexmedetomidine as an Adjuvant to Ropivacaine Inpatient Quality of Recovery Scores Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial

Cost‐effectiveness of forced air warming during sedation in the cardiac catheterisation laboratory

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