title: Paravertebral blocks in patients undergoing mastectomy with or without immediate reconstruction provides improved pain control and decreased postoperative nausea and vomiting.
abstract: BACKGROUND
  Mastectomy is associated with postoperative nausea and pain. We evaluated whether paravertebral block (PVB) use altered opioid use, antiemetic use, and length of stay in patients undergoing mastectomy.
  
  
  METHODS
  We performed a retrospective cohort analysis of all patients who underwent mastectomy with or without PVB from 2008 to 2010. Patient demographics, operative procedure, intraoperative medications, postoperative opioid and antiemetic use, and length of stay were reviewed. Statistical analysis included univariable and multivariable analysis.
  
  
  RESULTS
  A total of 605 patients were identified, of whom 526 patients were evaluable. A total of 294 patients underwent mastectomy without PVB (132 bilateral), and 232 patients underwent mastectomy with PVB (148 bilateral). Immediate reconstruction was performed in 203 (39 %) patients. Need for any postoperative antiemetic was less frequent in the PVB group (39 vs. 57 %, p < 0.0001). Day of surgery opioid use was lower in the PVB group than the non-PVB group (mean ± SD 40.1 ± 15.2 vs. 47.6 ± 17.7 morphine equivalents, p < 0.0001). Decreased opioid use was seen in unilateral mastectomy without reconstruction and bilateral mastectomy with and without immediate reconstruction. The proportion of patients discharged within 36 h of surgery was significantly higher in the PVB group (55 vs. 42 %, p = 0.0031). On multivariable analysis controlling for year of surgery, patient age and surgeon, PVB use affected antiemetic use and opioid use but not hospital length of stay.
  
  
  CONCLUSIONS
  PVB results in decreased opioid use and decreased need for postoperative antiemetic medication in patients undergoing mastectomy. The greatest benefit is seen in patients undergoing bilateral mastectomy with immediate breast reconstruction.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Aodhnait S
authors.initials: AS
authors.lastname: Fahy
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.forename: Benzon M
authors.initials: BM
authors.lastname: Dy
authors.forename: Nora Serag
authors.initials: NS
authors.lastname: Eldin
authors.forename: Scott
authors.initials: S
authors.lastname: Harmsen
authors.forename: Hans
authors.initials: H
authors.lastname: Sviggum
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D009407:Nerve Block; D059408:Pain Management; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics