title: Persistent postmastectomy pain and pain-related physical and emotional functioning with and without a continuous paravertebral nerve block: a prospective 1-year follow-up assessment of a randomized, triple-masked, placebo-controlled study.
abstract: BACKGROUND
  In a previous randomized, triple-masked, placebo-controlled study, the authors demonstrated that extending a single-injection paravertebral nerve block with a multiple-day perineural local anesthetic infusion improves analgesia and decreases pain-related dysfunction during the 3-day infusion but not subsequent to catheter removal within 1 month after mastectomy. This report describes a prospective follow-up study of the previously published trial to investigate the possibility that extending a single-injection paravertebral block with a multiple-day infusion may decrease persistent postsurgical pain as well as pain-induced emotional and functional dysfunction 1 year after mastectomy.
  
  
  METHODS
  Subjects undergoing uni- or bilateral mastectomy received unilateral (n = 24) or bilateral (n = 36) single-injection thoracic paravertebral block(s) with ropivacaine and perineural catheter(s). The subjects were randomized to receive either ropivacaine 0.4 % (n = 30) or normal saline (n = 30) via their catheters until the catheters were removed on postoperative day 3. Chronic pain and pain-related physical and emotional dysfunction were measured using the Brief Pain Inventory (BPI).
  
  
  RESULTS
  No statistically significant difference between treatments 3 months after surgery was observed with the BPI. In contrast, after 12 months, only 4 subjects (13 %) who had received a perineural ropivacaine infusion reported pain-induced dysfunction compared with 14 (47 %) who had received saline infusion (P = 0.011). At 12 months, the mean BPI was 1.6 ± 4.6 for the subjects who received ropivacaine versus 5.9 ± 11.3 for the subjects who received saline (P = 0.007).
  
  
  CONCLUSIONS
  Adding a multiple-day, continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block may result in a lower incidence of pain as well as pain-related physical and emotional dysfunction 1 year after mastectomy.
authors.affiliation: Department of Anesthesiology, University of California San Diego, San Diego, CA, USA, bilfeld@ucsd.edu.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Ilfeld
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Madison
authors.forename: Preetham J
authors.initials: PJ
authors.lastname: Suresh
authors.forename: NavParkash S
authors.initials: NS
authors.lastname: Sandhu
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Kormylo
authors.forename: Nisha
authors.initials: N
authors.lastname: Malhotra
authors.forename: Vanessa J
authors.initials: VJ
authors.lastname: Loland
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wallace
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mascha
authors.forename: Zekun
authors.initials: Z
authors.lastname: Xu
authors.forename: Cindy H
authors.initials: CH
authors.lastname: Wen
authors.forename: Anya C
authors.initials: AC
authors.lastname: Morgan
authors.forename: Anne M
authors.initials: AM
authors.lastname: Wallace
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007263:Infusions, Parenteral; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D000077212:Ropivacaine; D013315:Stress, Psychological / Q000209:etiology*
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine