The effect on improvement of recovery and pain scores of paravertebral block immediately before breast surgery

Abstract

PVB given before surgery in combination with GA could provide better postoperative analgesia and better QoR than did GA alone in patients undergoing surgery for unilateral breast cancer.

Effects of anesthetic interventions on breast cancer behavior, cancer-related patient outcomes, and postoperative recovery

“…One retrospective study of 526 patients showed that use of paravertebral block vs no paravertebral block significantly decreased need for postoperative emetic rescue, opioid use on the day of surgery, and time to discharge [62]. An additional prospective study showed that use of paravertebral block improved the combined “Quality of Recovery” score on POD 1 [39]. Only one retrospective study of 337 patients was unable to show a significant difference in use of morphine on POD0, pain scores, or nausea when comparing patients receiving paravertebral block vs no paravertebral block for breast cancer surgery [60].…”

“…Administration of morphine may also contribute to angiogenesis; at medically relevant concentrations, morphine can stimulate not only endothelial proliferation, survival, and cell cycle progression but also angiogenesis in both in vitro and in vivo breast cancer models [38]. It was demonstrated that tramadol, but not morphine can overcome the ability of surgical stress to decrease the activity of NK cells in rats perhaps accounting for tramadol’s ability to block lung metastasis in rats [39, 40]. Further supporting the presumed immunosuppressive role of morphine, one study looking at opioids administered to patients for acute postoperative pain, found that morphine caused a decrease in lymphocyte proliferation below basal levels 2 hours after treatment whereas tramadol-treated patients’ lymphocyte counts returned to baseline in the same time period [41].…”

“…The studies that are more clearly in favor of paravertebral block in patients receiving breast cancer surgery are those looking at postoperative pain. In one prospective trial, patients receiving general anesthesia plus paravertebral block versus general anesthesia alone had a significantly improved quality of recovery, a combined score of various different metrics [39]. One randomized controlled trial looking at paravertebral block as an adjunct to TIVA with propofol versus sham subcutaneous local anesthetic with sevoflurane-based general anesthesia and fentanyl, found significantly decreased intraoperative use of fentanyl and postoperative pain scores in patients receiving paravertebral blocks [53].…”

Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study

“…A 22-gauge, 3.5-in spinal needle (Terumo ® spinal needle, Terumo Corporation, Tokyo, Japan) was subsequently inserted according to a previously described method [13]. Moreover, 8 mL of 0.5% levobupivacaine with 1:400,000 epinephrine was injected after negative aspiration of blood, air, or cerebrospinal fluid at the T2, T4, and T6 levels.…”

Thoracal paravertebral block for breast surgery

“…It is considered that, acute postoperative pain after breast surgery is around 40%, and this rate becomes much higher as result of inadequate pain management. 40 TPVB application after mastectomy improves shoulder movement restricted due to pain. 41 Karmakar 40 a has been reported that the duration of postoperative analgesia was average of 23 hours (range 9-38 hours) fort he patients applied TPVB by bolus injection.…”