title: Continuous paravertebral block for postoperative pain compared to general anaesthesia and wound infiltration for major oncological breast surgery.
abstract: We hypothesized that improved acute postoperative pain relief will be achieved using general anaesthesia (GA) either in combination with continuous thoracic paravertebral block (GA-cPVB) or single shot (GA-sPVB) as compared to GA supplemented by local wound infiltration (GA-LWI) after unilateral major breast cancer surgery. A randomised controlled trial was conducted in 46 adult women in a day-care or short-stay hospital setting after major breast cancer surgery. Pain-intensity was measured using an 11-point visual analogue scale (VAS) until postoperative day 2. GA-sPVB was stopped due to slow inclusion. No significant difference in VAS score was noted between GA-LWI (VAS median 0.5 (interquartile range 0.18-2.00)) and GA-cPVB, (VAS 0.3 (0.00-1.55, p = 0.195)) 24 hours after surgery or at any point postoperatively until postoperative day 2. We conclude that both GA-LWI and GA-cPVB anaesthetic techniques are equally effective in treatment of acute postoperative pain after major oncological breast surgery. As GA-LWI is easily to perform with fewer complications and it is more cost-effective it should be preferred over GA-cPVB.
authors.affiliation: Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
authors.forename: Esther A C
authors.initials: EA
authors.lastname: Bouman
authors.affiliation: Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
authors.forename: Maurice
authors.initials: M
authors.lastname: Theunissen
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Alfons Gh
authors.initials: AG
authors.lastname: Kessels
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Kristien Bmi
authors.initials: KB
authors.lastname: Keymeulen
authors.affiliation: Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
authors.forename: Elbert Aj
authors.initials: EA
authors.lastname: Joosten
authors.affiliation: Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands ; Department of Anaesthesiology, ICU and Perioperative Medicine, HMC, Doha, Qatar.
authors.forename: Marco Ae
authors.initials: MA
authors.lastname: Marcus
authors.affiliation: Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
authors.forename: Wolfgang F
authors.initials: WF
authors.lastname: Buhre
authors.affiliation: Department of Anaesthesiology and Pain Management, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
authors.forename: Hans-Fritz
authors.initials: HF
authors.lastname: Gramke
keywords: Breast surgery; Paravertebral block; Postoperative pain; Randomized controlled trial; Wound infiltration