title: Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation.
abstract: OBJECTIVE
  Retrospective studies have associated perioperative regional anesthesia/analgesia during mastectomy for breast cancer with a decreased incidence of cancer recurrence. However, to date, no prospective data from a randomized controlled trial have been reported. In a previous study we found that extending a single-injection paravertebral block with a multiple-day perineural local anesthetic infusion improves analgesia. This follow-up study investigates the rates of cancer recurrence for the single-injection and multiple-day infusion treatments.
  
  
  METHODS
  Patients undergoing unilateral (n = 24) or bilateral mastectomy (n = 36) were included in the study. All patients had been diagnosed with breast cancer or tumor in situ, except for six patients who were receiving prophylactic bilateral mastectomy and were excluded from analyses. Patients received unilateral or bilateral single-injection thoracic paravertebral block(s) corresponding to their surgical site(s) with ropivacaine and perineural catheter(s). Subsequently, patients were randomized to receive either ropivacaine 0.4% (n = 30) or normal saline (n = 30) via their catheter(s) until catheter removal on postoperative day 3. Cancer recurrence from the date of surgery until at least 2 years post surgery was investigated via chart review.
  
  
  RESULTS
  Five of the 54 (9.2%) patients experienced a cancer recurrence following mastectomy-3 of 26 (11.5%) of the patients with perineural ropivacaine and 2 of 28 (7.1%) of the patients with perineural saline.
  
  
  CONCLUSIONS
  This pilot study found no evidence that extending a single-injection paravertebral block with a multi-day perineural local anesthetic infusion decreases the risk of post-mastectomy cancer recurrence. However, due to the small sample size of this investigation, further research is needed to draw definitive conclusions.
authors.affiliation: Department of Psychiatry, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Daphna M
authors.identifier: http://orcid.org/0000-0003-2572-7778
authors.initials: DM
authors.lastname: Finn
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA. bilfeld@ucsd.edu.|Department of Anesthesiology, Outcomes Research Consortium, Cleveland, OH, USA. bilfeld@ucsd.edu.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Ilfeld
authors.affiliation: Department of Surgery, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Unkart
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Madison
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Preetham J
authors.initials: PJ
authors.lastname: Suresh
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Nav Parkash S
authors.initials: NPS
authors.lastname: Sandhu
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Kormylo
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.|Department of Anesthesiology, Lawrence and Memorial Hospital, New London, CT, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Malhotra
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.|Department of Anesthesiology, University of Washington, Seattle, WA, USA.
authors.forename: Vanessa J
authors.initials: VJ
authors.lastname: Loland
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wallace
authors.affiliation: Department of Ophthalmology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Cindy H
authors.initials: CH
authors.lastname: Wen
authors.affiliation: Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Anya C
authors.initials: AC
authors.lastname: Morgan
authors.affiliation: Department of Surgery, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
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 / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D011184:Postoperative Period; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Cancer recurrence; Continuous paravertebral block; Mastectomy