[Effectiveness of analgesic techniques after breast surgery: a meta-analysis].
OBJECTIVE
To evaluate the effectiveness of locoregional analgesic techniques (thoracic paravertebral block (TPVB), wound infiltration (WI)) after breast surgery.


METHODS
Meta-analysis.


METHODS
Searches of Medline and Cochrane were performed using the search terms "breast surgery" and "local anaesthetics" and "infiltration" or "paravertebral block". Manual searches were also performed. Two independent investigators assessed the publications and extracted the data. Inclusion criteria were randomised controlled trials that evaluated effectiveness of single-injection TPVB or WI with local anaesthetics after breast surgery. Postoperative pain scores evaluated by visual analogic scale (VAS) during the first six hours (H6), at twelve hours (H12) and incidence of postoperative nausea and vomiting (PONV) were collected.


RESULTS
Nine studies met inclusion criteria with five trials that evaluated paravertebral block (N=253) and 4 studies that evaluated wound infiltration (N=174). TPVB decreased significantly VAS at H6 (Weighted mean difference (WMD)=-18 [-5;-32] ; P=0.007) and at H12 (WMD=-12[-20;-4] ; P=0.001) and the risk of PONV (relative risk=0.39 [0.26; 0.57] ; P<0.00001). WI did not decrease significantly VAS for postoperative pain and PONV.


CONCLUSIONS
Single injection TPVB in contrast to WI is effective for analgesia after breast surgery and decreases PONV.
Marret
E
E
Département d'anesthésie-réanimation, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France. emmanuel.marret@tnn.ap-hop-paris.fr
Vigneau
A
A
Salengro
A
A
Noirot
A
A
Bonnet
F
F
D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use; D001940:Breast / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D010149:Postoperative Pain / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D000700:Analgesics