Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study

• Published in: Annals of surgical oncology 2015-06, Vol.22 (6), p.2017-2025
• Main Authors: Ilfeld, Brian M., Madison, Sarah J., Suresh, Preetham J., Sandhu, NavParkash S., Kormylo, Nicholas J., Malhotra, Nisha, Loland, Vanessa J., Wallace, Mark S., Mascha, Edward J., Xu, Zekun, Wen, Cindy H., Morgan, Anya C., Wallace, Anne M.
• Format: Article
• Language: English
• Subjects: Adult; Amides - administration & dosage; Anesthetics, Local - administration & dosage; Breast Neoplasms - pathology; Breast Neoplasms - psychology; Breast Neoplasms - surgery; Breast Oncology; Female; Follow-Up Studies; Humans; Infusions, Parenteral; Mastectomy - adverse effects; Medicine; Medicine & Public Health; Middle Aged; Nerve Block; Oncology; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Prognosis; Prospective Studies; Ropivacaine; Stress, Psychological - etiology; Surgery; Surgical Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-4248-7

Background In a previous randomized, triple-masked, placebo-controlled study, the authors demonstrated that extending a single-injection paravertebral nerve block with a multiple-day perineural local anesthetic infusion improves analgesia and decreases pain-related dysfunction during the 3-day infusion but not subsequent to catheter removal within 1 month after mastectomy. This report describes a prospective follow-up study of the previously published trial to investigate the possibility that extending a single-injection paravertebral block with a multiple-day infusion may decrease persistent postsurgical pain as well as pain-induced emotional and functional dysfunction 1 year after mastectomy. Methods Subjects undergoing uni- or bilateral mastectomy received unilateral ( n  = 24) or bilateral ( n  = 36) single-injection thoracic paravertebral block(s) with ropivacaine and perineural catheter(s). The subjects were randomized to receive either ropivacaine 0.4 % ( n  = 30) or normal saline ( n  = 30) via their catheters until the catheters were removed on postoperative day 3. Chronic pain and pain-related physical and emotional dysfunction were measured using the Brief Pain Inventory (BPI). Results No statistically significant difference between treatments 3 months after surgery was observed with the BPI. In contrast, after 12 months, only 4 subjects (13 %) who had received a perineural ropivacaine infusion reported pain-induced dysfunction compared with 14 (47 %) who had received saline infusion ( P  = 0.011). At 12 months, the mean BPI was 1.6 ± 4.6 for the subjects who received ropivacaine versus 5.9 ± 11.3 for the subjects who received saline ( P  = 0.007). Conclusions Adding a multiple-day, continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block may result in a lower incidence of pain as well as pain-related physical and emotional dysfunction 1 year after mastectomy.