Single-Injection Paravertebral Block Before General Anesthesia Enhances Analgesia After Breast Cancer Surgery With and Without Associated Lymph Node Biopsy

Paravertebral block (PVB) seems to decrease postoperative pain and postoperative nausea and vomiting (PONV) after breast surgery, but the studies have not been placebo controlled. We studied 60 patients scheduled for breast cancer surgery randomly given single-injection PVB at T3 with bupivacaine 5...

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Bibliographic Details
Published in:	Anesthesia and analgesia Vol. 99; no. 6; pp. 1837 - 1843
Main Authors:	Kairaluoma, Pekka M., Bachmann, Martina S., Korpinen, Aulikki K., Rosenberg, Per H., Pere, Pertti J.
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD International Anesthesia Research Society 01-12-2004 Lippincott
Subjects:	Aged Analgesics, Opioid - administration & dosage Analgesics, Opioid - therapeutic use Anesthesia Anesthesia, General Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Local Biological and medical sciences Breast Neoplasms - surgery Bupivacaine Double-Blind Method Female Humans Male Mastectomy Medical sciences Middle Aged Movement Nerve Block Oxycodone - administration & dosage Oxycodone - therapeutic use Pain Measurement Pain, Postoperative - drug therapy Postoperative Nausea and Vomiting - epidemiology Preanesthetic Medication Recovery Room Sentinel Lymph Node Biopsy Shoulder - physiology Supine Position Mammary gland diseases Analgesia Lymph node Biopsy Surgery Single dose General anesthesia Breast cancer Malignant tumor
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Summary:	Paravertebral block (PVB) seems to decrease postoperative pain and postoperative nausea and vomiting (PONV) after breast surgery, but the studies have not been placebo controlled. We studied 60 patients scheduled for breast cancer surgery randomly given single-injection PVB at T3 with bupivacaine 5 mg/mL (1.5 mg/kg) or saline before general anesthesia. The patient and attending investigators were blinded; the PVB or the sham block was performed behind a curtain by an anesthesiologist not involved in the study. The patients given PVB with bupivacaine needed 40% less IV opioid medication (primary outcome variable) in the postanesthesia care unit, had a longer latency to the first opioid dose, and had less pain at rest after 24 h than the control patients (P < 0.01). They also had less PONV in the postanesthesia care unit (P < 0.05), were less sedated until 90 min (P < 0.05), and performed better in the digit symbol substitution test at 90 min and the ocular coordination test 60–120 min after surgery (P < 0.05). The average peak bupivacaine plasma concentration was 750 ng/mL. One patient had bilateral convulsions immediately after bupivacaine injection. We conclude that PVB before general anesthesia for breast cancer surgery reduced postoperative pain, opioid consumption, and occurrence of PONV and improved recovery from anesthesia.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0003-2999 1526-7598
DOI:	10.1213/01.ANE.0000136775.15566.87