title: A Prospective, Randomized, Controlled Trial of Paravertebral Block versus General Anesthesia Alone for Prosthetic Breast Reconstruction.
abstract: BACKGROUND
  Paravertebral blocks have gained popularity because of ease of implementation and a shift toward ambulatory breast surgery procedures. Previous retrospective studies have reported potential benefits of paravertebral blocks, including decreased narcotic and antiemetic use.
  
  
  METHODS
  The authors conducted a prospective controlled trial of patients undergoing breast reconstruction over a 3-year period. The patients were randomized to either a study group of paravertebral blocks with general anesthesia or a control group of general anesthesia alone. Demographic and procedural data, in addition to data regarding pain and nausea patient-reported numeric scores and consumption of opioid and antiemetic medications, were recorded.
  
  
  RESULTS
  A total of 74 patients were enrolled to either the paravertebral block (n = 35) or the control group (n = 39). There were no significant differences in age, body mass index, procedure type, or cancer diagnosis between the two groups. Patients who received a paravertebral block required less opioid intraoperatively and postoperatively combined compared with patients who did not receive paravertebral blocks (109 versus 246 fentanyl equivalent units; p < 0.001), and reported significantly lower pain scores at 0 to 1 (3.0 versus 4.6; p = 0.02), 1 to 3 (2.0 versus 3.2; p = 0.01), and 3 to 6 (1.9 versus 2.7; p = 0.04) hours postoperatively. The study group also consumed less antiemetic medication (0.7 versus 2.1; p = 0.05).
  
  
  CONCLUSIONS
  Incorporating paravertebral blocks carries considerable potential for improving pathways for breast cancer patients undergoing breast reconstruction--with minimal procedure-related morbidity. This is the first prospective study designed to assess paravertebral blocks in the setting of prosthetic breast reconstruction.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Houston, Texas.|From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Omer
authors.initials: O
authors.lastname: Wolf
authors.affiliation: Houston, Texas.|From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Clemens
authors.affiliation: Houston, Texas.|From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Ronaldo V
authors.initials: RV
authors.lastname: Purugganan
authors.affiliation: Houston, Texas.|From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Crosby
authors.affiliation: Houston, Texas.|From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Kowalski
authors.affiliation: Houston, Texas.|From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Spencer S
authors.initials: SS
authors.lastname: Kee
authors.affiliation: Houston, Texas.|From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Houston, Texas.|From the Departments of Plastic Surgery and Anesthesia, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Farzin
authors.initials: F
authors.lastname: Goravanchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D018427:Breast Implants; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D055815:Young Adult