title: Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy.
abstract: Paravertebral block (PVB) seems to decrease postoperative pain and postoperative nausea and vomiting (PONV) after breast surgery, but the studies have not been placebo controlled. We studied 60 patients scheduled for breast cancer surgery randomly given single-injection PVB at T3 with bupivacaine 5 mg/mL (1.5 mg/kg) or saline before general anesthesia. The patient and attending investigators were blinded; the PVB or the sham block was performed behind a curtain by an anesthesiologist not involved in the study. The patients given PVB with bupivacaine needed 40% less IV opioid medication (primary outcome variable) in the postanesthesia care unit, had a longer latency to the first opioid dose, and had less pain at rest after 24 h than the control patients (P < 0.01). They also had less PONV in the postanesthesia care unit (P < 0.05), were less sedated until 90 min (P < 0.05), and performed better in the digit symbol substitution test at 90 min and the ocular coordination test 60-120 min after surgery (P < 0.05). The average peak bupivacaine plasma concentration was 750 ng/mL. One patient had bilateral convulsions immediately after bupivacaine injection. We conclude that PVB before general anesthesia for breast cancer surgery reduced postoperative pain, opioid consumption, and occurrence of PONV and improved recovery from anesthesia.
authors.affiliation: *Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland; and †Rheumatism Foundation Hospital, Heinola, Finland.
authors.forename: Pekka M
authors.initials: PM
authors.lastname: Kairaluoma
authors.forename: Martina S
authors.initials: MS
authors.lastname: Bachmann
authors.forename: Aulikki K
authors.initials: AK
authors.lastname: Korpinen
authors.forename: Per H
authors.initials: PH
authors.lastname: Rosenberg
authors.forename: Pertti J
authors.initials: PJ
authors.lastname: Pere
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General; D000779:Anesthetics, Local; D001943:Breast Neoplasms / Q000601:surgery*; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008408:Mastectomy; D008875:Middle Aged; D009068:Movement; D009407:Nerve Block; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011229:Preanesthetic Medication; D011997:Recovery Room; D021701:Sentinel Lymph Node Biopsy; D012782:Shoulder / Q000502:physiology; D016683:Supine Position
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010098:Oxycodone; D002045:Bupivacaine