Comparison of single-injection ultrasound-guided approach versus multilevel landmark-based approach for thoracic paravertebral blockade for breast tumor resection: a retrospective analysis at a tertiary care teaching institution

The role of thoracic paravertebral blockade (TPVB) in decreasing opioid requirements in breast cancer surgery is well documented, and there is mounting evidence that this may improve survival and reduce the rate of malignancy recurrence following cancer-related mastectomy. We compared the two techni...

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Bibliographic Details
Published in:Journal of pain research 2017-01, Vol.10, p.1487-1492
Main Authors: Saran, Jagroop Singh, Hoefnagel, Amie L, Skinner, Kristin A, Feng, Changyong, Smith, Daryl Irving
Format: Article
Language:English
Subjects:
Analgesics
Anesthesia
Anesthesiology
Biopsy
Breast cancer
Dentistry
Dose-response relationship
Keywords: thoracic paravertebral block
Lymphatic system
Mastectomy
Medicine
Methods
Narcotics
Nerve block
Original Research
Pain
Patients
regional anesthesia
Studies
Surgery
Systematic review
Ultrasonic imaging
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Summary:The role of thoracic paravertebral blockade (TPVB) in decreasing opioid requirements in breast cancer surgery is well documented, and there is mounting evidence that this may improve survival and reduce the rate of malignancy recurrence following cancer-related mastectomy. We compared the two techniques currently in use at our institution, the anatomic landmark-guided (ALG) multilevel versus an ultrasound-guided (USG) single injection, to determine an optimal technique. We retrospectively reviewed records of patients who received TPVB from January 2013 to December 2014. Perioperative opioid use, post anesthesia care unit (PACU) pain scores and length of stay, block performance, and complications were compared between the two groups. We found no statistical difference between the two approaches in the studied outcomes. We did find that the number of times attending physicians in the ALG group took over the blocks from residents was significantly greater than that of the USG group ( =0.006) and more local anesthetic was used in the USG group ( =0.04). This study compared the ALG approach with the USG approach for patients undergoing mastectomy for breast cancer. Based on our observations, an attending physician is more likely to take over an ALG injection, and more local anesthetic is administered during USG single injection.
ISSN:1178-7090
1178-7090
DOI:10.2147/JPR.S135973