Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection.
BACKGROUND
Regional anesthesia improves postoperative analgesia and enhances quality of recovery (QoR) after ambulatory surgery. This randomized, double-blinded, parallel-group, placebo-controlled trial examines the effects of multilevel ultrasound-guided paravertebral blocks (PVBs) and total intravenous anesthesia on QoR after ambulatory breast tumor resection.


METHODS
Sixty-six women were randomized to standardized general anesthesia (control group) or PVBs and propofol-based total intravenous anesthesia (PVB group). The PVB group received T1-T5 PVBs with 5 ml of 0.5% ropivacaine per level, whereas the control group received sham subcutaneous injections. Postoperative QoR was designated as the primary outcome. The 29-item ambulatory QoR tool was administered in the preadmission clinic, before discharge, and on postoperative days 2, 4, and 7. Secondary outcomes included block success, pain scores, intra- and postoperative morphine consumption, time to rescue analgesia, incidence of nausea and vomiting, and hospital discharge time.


RESULTS
Data from sixty-four patients were analyzed. The PVB group had higher QoR scores than control group upon discharge (146 vs. 131; P < 0.0001) and on postoperative day 2 (145 vs. 135; P = 0.013); improvements beyond postoperative day 2 lacked statistical significance. None of the PVB group patients required conversion to inhalation gas-based general anesthesia or experienced block-related complications. PVB group patients had improved pain scores on postanesthesia care unit admission and discharge, hospital discharge, and postoperative day 2; their intraoperative morphine consumption, incidence of nausea and vomiting, and discharge time were also reduced.


CONCLUSIONS
Combining multilevel PVBs with total intravenous anesthesia provides reliable anesthesia, improves postoperative analgesia, enhances QoR, and expedites discharge compared with inhalational gas- and opioid-based general anesthesia for ambulatory breast tumor resection.
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada, and Department of Anesthesia, St. Michael's Hospital, and Keenan Research Centre, Li Ka Shing Knowledge Institute, and Department of Anesthesia, Women's College Hospital (F.W.A.); Department of Anesthesia, University of Toronto, and Department of Anesthesia, Women's College Hospital (P.J.M.); Department of Surgery, Women's College Hospital, University of Toronto (T.C., J.M.E., J.L.S.); Department of Anesthesia, University of Toronto, and Department of Anesthesia, Women's College Hospital, and Department of Anesthesia, Sunnybrook Hospital (A.M.); Women's College Research Institute, University of Toronto (W.W.); and Department of Anesthesia, University of Toronto; and Department of Anesthesia, Toronto Western Hospital, University Health Network (V.W.C.).
Faraj W
FW
Abdallah
Pamela J
PJ
Morgan
Tulin
T
Cil
Andrew
A
McNaught
Jaime M
JM
Escallon
John L
JL
Semple
Wei
W
Wu
Vincent W
VW
Chan
D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000577:Amides; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D001943:Breast Neoplasms / Q000601:surgery*; D002170:Canada / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D015742:Propofol; D011446:Prospective Studies; D000077212:Ropivacaine; D018084:Ultrasonography, Interventional / Q000379:methods*
D000577:Amides; D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000077212:Ropivacaine; D015742:Propofol