The Impact of Paravertebral Block Analgesia on Breast Cancer Survival After Surgery.
The impact of regional anesthesia on breast cancer recurrence is controversial. We tested the hypothesis that the use of paravertebral block (PVB) analgesia during breast cancer surgery prolongs the recurrence-free survival (RFS) and overall survival (OS) of women with breast cancer.



Seven hundred ninety-two women with nonmetastatic breast cancer were included in this retrospective study. Patients were divided based on the administration of PVB analgesia for mastectomy surgeries. One hundred ninety-eight (25%) were given a PVB, the remainder were treated with opioid-based analgesia. Propensity score matching was developed using several variables. Univariate and multivariate analyses were used to assess the impact of PVB analgesia on RFS and OS.



The median follow-up times for RFS and OS were 5.8 and 6 years, respectively. In the propensity score matching model, a total of 396 women were included in each group of treatment (non-PVB group, n = 198 vs PVB group, n = 198). As expected, the fentanyl consumption was significantly lower in PVB (122.8 ± 77.85 μg) patients than non-PVB subjects (402.23 ± 343.8 μg). Other variables were not statistically significant. After adjusting for several important covariates, the analysis indicated that the use of PVB is not associated with a significant change in RFS [1.60 (0.81-3.16), P = 0.172] or OS [1.28 (0.55-3.01)] survival.



This retrospective study does not support the hypothesis that the use of regional analgesia is associated with longer survival after surgery for breast cancer.
From the *Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center; †Anesthesiology and Surgical Oncology Research Group; and Departments of ‡Breast Medical Oncology, §Breast Surgical Oncology, and ∥Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Juan P
JP
Cata
Mariana
M
Chavez-MacGregor
Vicente
V
Valero
Walter
W
Black
Daliah M
DM
Black
Farzin
F
Goravanchi
Ifey C
IC
Ifeanyi
Mike
M
Hernandez
Andrea
A
Rodriguez-Restrepo
Vijaya
V
Gottumukkala
D000328:Adult; D000698:Analgesia / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D005283:Fentanyl