Double-blinded, placebo-controlled, prospective randomized trial evaluating the efficacy of paravertebral block with and without continuous paravertebral block analgesia in outpatient breast cancer surgery.
BACKGROUND
Paravertebral block (PVB) is an effective alternative to general anesthesia for breast cancer surgery. Continuous paravertebral block (CPVB) anesthesia may extend postoperative analgesia at home and improve quality of early postoperative recovery of breast cancer patients.


OBJECTIVE
This double-blinded randomized trial was conducted to compare degree of pain, nausea, mood, level of symptom distress, and time to return to normal daily activity between PVB and PVB + CPVB in patients undergoing outpatient breast cancer surgery.


METHODS
Between July 2003 and April 2008 we randomly assigned 94 (73 evaluable) patients in a 1:1:1 ratio with early breast cancer to single injection PVB followed by CPVB infusion of 0.1% or 0.2% ropivacaine vs placebo (saline) for 48 hours postoperatively for unilateral breast cancer surgery without reconstruction. The primary study endpoint was the degree of pain, nausea, mood state, level of symptom distress, and recovery time.


RESULTS
Of the 468 patients assessed for eligibility, 94 consented and 21 with incomplete data or follow-up were excluded, leaving 73 subjects for analysis. There was no clinically significant difference in degree of postoperative pain, nausea, mood state, level of symptom distress, or return to normal activity among the three study groups.


CONCLUSIONS
The current study does not support the routine use of continuous paravertebral catheter anesthesia in patients undergoing operative treatment for breast cancer.
Buckenmaier
Chester C
CC
Defense and Veterans Pain Management Initiative, Anesthesia & Operative Service, Walter Reed Army Medical Center, Washington, District of Columbia 20307-5001, USA. chester.buckenmaier@amedd.army.mil
Kwon
Kyung H
KH
Howard
Robin S
RS
McKnight
Geselle M
GM
Shriver
Craig D
CD
Fritz
William T
WT
Garguilo
Gerard A
GA
Joltes
Kristin H
KH
Stojadinovic
Alexander
A
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000698:Analgesia / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010919:Placebos / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
D010919:Placebos