Thoracic paravertebral block for breast surgery

Stamatiou, Georgia; Athanasiou, E.; Simeoforidou, Marina; Bakos, P.; Michaloudis, D.

doi:10.1111/j.1365-2044.2004.03848.x

Cited by 9 publications

(4 citation statements)

References 12 publications

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“…Analgesia in both our groups was clinically satisfactory, but patients given paravertebral analgesia had better outcomes, with less immediate postoperative pain, reflected by a reduction in VAS score of 21%.The intensity of pain in our study was broadly comparable with two randomized studies of paravertebral analgesia (with or without concomitant general anesthesia) versus general anesthesia alone [ 2 , 4 ].In an animal model, optimum postoperative analgesia independently reduced the metastatic burden in rats inoculated with breast adenocarcinoma cells following surgery[ 11 ], which informed our choice of the most intense pain in the immediate two postoperative hours as one of our primary outcome measures.…”

Section: Discussionsupporting

confidence: 71%

Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

et al. 2015

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ObjectivesThe contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery.MethodsPatients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121) or fentanyl with sevoflurane general anesthesia (GA group, n = 126). Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests.ResultsPatients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours), less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,), less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5]), but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg). Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions.ConclusionsThe combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery.Trial RegistrationClinicalTrial.gov NCT00418457

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Section: Discussionsupporting

confidence: 71%

Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

et al. 2015

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“…Currently there is no solid research supporting the benefit of regional anesthesia over general anesthesia for pregnant patients [31]. A thoracic paravertebral block technique may be associated with faster recovery rates and less post-operative nausea but its use is not routine [32], with only a single case report describing its success in a pregnant breast cancer patient [33].…”

Section: Surgery and Radiation Therapymentioning

confidence: 98%

Breast cancer in pregnancy: a literature review

Molckovsky

Madarnas

2007

Breast Cancer Res Treat

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Purpose Breast cancer in pregnancy is a clinically challenging situation for patients and their physicians. A review of the literature was performed to help identify optimal treatment strategies. Methods A Medline search between 1966 to the present using the keywords ''breast'', ''carcinoma'', and ''pregnancy'' revealed numerous hits, from which English-language articles including epidemiologic studies, case series, and general summaries were reviewed. Results There is a paucity of prospective studies regarding diagnosis and treatment of breast cancer in pregnancy due to its rarity. However a general review of the literature database reveals that women diagnosed with breast cancer during pregnancy have similar disease characteristics to age-matched controls. Surgery remains the mainstay of treatment of breast cancer during pregnancy, and in some circumstances breast-conserving surgery is an acceptable option. Adjuvant treatment can proceed with some modifications that minimize harm to the fetus, namely limiting radiation exposure and timing chemotherapy properly. Post-partum decisions regarding lactation and future fertility should be addressed on a per-patient basis. Conclusion Breast cancer in pregnancy is an uncommon phenomenon but one which poses dilemmas for patients and their physicians. A multi-disciplinary approach is recommended for optimal clinical-decision making.

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“…[14,15] It has been successfully applied in sternotomy, breast surgery, abdominoplasty, and laparoscopic cholecystectomy. [16–19]…”

Section: Introductionmentioning

confidence: 99%

The efficacy of thoracic paravertebral block for thoracoscopic surgery

Hu¹,

Liú

Wang³

et al. 2018

Medicine

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Background:The efficacy of thoracic paravertebral block for thoracoscopic surgery remains controversial. We conduct a systematic review and meta-analysis to explore the impact of thoracic paravertebral block on thoracoscopic surgery.Methods:We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2018 for randomized controlled trials (RCTs) assessing the effect of thoracic paravertebral block on thoracoscopic surgery. This meta-analysis is performed using the random-effect model.Results:Six RCTs involving 300 patients are included in the meta-analysis. Overall, compared with control group for thoracoscopic surgery, thoracic paravertebral block results in significantly reduced pain scores within 6 hours (Std. MD = −2.15; 95% CI = −3.67 to −0.62; P = .006), postoperative anesthesia consumption during 48 hours (Std. MD = −1.81; 95% CI = −3.05 to −0.58; P = .004), and hospital stay (Std. MD = −1.19; 95% CI = −2.13 to −0.26; P = .01), but has no important impact on pain scores at 24 hours (Std. MD = −1.10; 95% CI = −2.77–0.57; P = .20), and 48 hours (Std. MD = −1.25; 95% CI = −2.86–0.36; P = .13).Conclusions:Thoracic paravertebral block can substantially enhance pain management for thoracoscopic surgery.

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Thoracic paravertebral block for breast surgery

Cited by 9 publications

References 12 publications

Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

Breast cancer in pregnancy: a literature review

The efficacy of thoracic paravertebral block for thoracoscopic surgery

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