Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial

• Published in: Canadian journal of anesthesia 2015-03, Vol.62 (3), p.241-251
• Main Authors: Wu, Jiang, Buggy, Donal, Fleischmann, Edith, Parra-Sanchez, Ivan, Treschan, Tanja, Kurz, Andrea, Mascha, Edward J., Sessler, Daniel I.
• Format: Article
• Language: English
• Subjects: Analgesia; Analgesia, Epidural - methods; Analgesics, Opioid; Anesthesia, Conduction - methods; Anesthesia, General; Anesthesiology; Anesthetics, Inhalation; Anesthetics, Intravenous; Breast cancer; Breast Neoplasms - surgery; Cancer surgery; Cardiology; Clinical trials; Critical Care Medicine; Double-Blind Method; Female; Fentanyl; General anesthesia; Humans; Intensive; Medical screening; Medicine; Medicine & Public Health; Methyl Ethers; Middle Aged; Morphine; Narcotics; Nerve Block - methods; Pain Medicine; Pain, Postoperative - drug therapy; Pediatrics; Pneumology/Respiratory System; Propofol; Regional anesthesia; Reports of Original Investigations
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-014-0285-8

Background The contribution of regional anesthesia with thoracic paravertebral blockade to postoperative analgesia remains unclear. We compared the effect of a combination of paravertebral blockade and propofol general anesthesia (GA) with sevoflurane GA and opioid analgesia on postoperative pain and opioid use for patients undergoing breast cancer surgery. Methods Patients having breast cancer surgery were randomly assigned to paravertebral analgesia with propofol GA (PPA, n  = 187) or sevoflurane GA with perioperative opioid analgesia (SOA, n  = 199). The PPA and SOA groups were compared for opioid consumption and pain outcomes (on a 0-10 visual analogue scale [VAS]) at two hours postoperatively using superiority and inferiority statistics. We compared our results with previous publications in a meta-analysis. Results Compared with the SOA group, the PPA group experienced reduced median [interquartile range] pain VAS scores (1 [1,3] vs 2.5 [1,4], respectively; median difference −1.0; 99% confidence intervals [CI]: −1.5 to −0.5) and required less intraoperative fentanyl (50 [0, 125] µg vs 200 [100, 300] µg, respectively; median difference −100; 99% CI: −150 to −100) and less long-acting opioid (0 [0, 0] mg vs 3.0 [0, 12] mg, respectively, morphine equivalents; median difference −3; 99% CI: −4 to −2). Thus, non-inferiority was detected for all the above outcomes, and superiority tests for each outcome were highly significant in the expected directions ( P