Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study.
OBJECTIVE
Paravertebral block placement was the main anesthetic technique for modified radical mastectomy in our hospital until February 2014, when its combination with blocks targeting the pectoral musculature was initiated. We compared the analgesic effects of paravertebral blocks with or without blocks targeting the pectoral musculature for modified radical mastectomy.


METHODS
We retrospectively collected data from a single surgeon and anesthesiologist from June 1, 2012, to May 31, 2015. Intraoperative sedatives and analgesic requirements, time to the first analgesic request, postoperative analgesic doses, patient satisfaction, and complications were compared.


RESULTS
Fifty-four patients received a paravertebral block alone (PECS 0), and 46 received a paravertebral block combined with blocks targeting the pectoral musculature (PECS 1). The highest intraoperative effect-site concentration of propofol was significantly lower in the PECS 1 group than in the PECS 0 group [2.3 (1.5, 2.8) vs 2.5 (1.5, 4) μg/mL, p = 0.0014]. The intraoperative rescue analgesic dose was significantly lower in the PECS 1 group [0 (0, 25) vs 0 (0, 75) mg of ketamine, p = 0.0384]. Furthermore, the PECS 1 group had a significantly longer time to the first analgesic request [636.5 (15, 720) vs 182.5 (14, 720) min, p = 0.0001]. After further adjustment for age, body mass index, American Society of Anesthesiologists Physical Status classification, chronic pain history, incidence of a superficial cervical plexus block placement, and operation duration, blocks targeting the pectoral musculature were determined to be the only significant factor (hazard ratio, 0.36; 95% confidence interval, 0.23-0.58; p < 0.0001). Very few patients used potent analgesics including morphine and ketorolac; the cumulative use of morphine or ketorolac was similar in the study groups. However, the incidence of all analgesic use, namely morphine, ketorolac, acetaminophen, and celecoxib, was significantly lower in the PECS 1 group [3.5 (0, 6) vs 5 (0, 12), p < 0.0001].


CONCLUSIONS
Compared with the placement of a paravertebral block alone, combining blocks targeting the pectoral musculature with a paravertebral block for modified radical mastectomy reduced the sedative and analgesic requirements during operation and provided more effective postoperative analgesia.
Department of Anesthesiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, Republic of China.
Nai-Liang
NL
Li
Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, Republic of China.
Ben-Long
BL
Yu
Biostatistics Section, Office of Clinical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, Republic of China.
Chen-Fang
CF
Hung
D054810:Deep Sedation / Q000379:methods; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000379:methods; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013900:Thoracic Nerves; D018084:Ultrasonography, Interventional