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ANALGESIA

Thoracic Paravertebral Block for Breast Cancer Surgery: A Randomized Double-Blind Study

Jytte F. Moller, MD, PhD^*, Lone Nikolajsen, MD, PhD^*, Svein Aage Rodt, MD, PhD^*, Hanne Ronning, MD, and Palle S. Carlsson, MD, PhD^*

From the *Department of Anesthesiology; Danish Pain Research Center; and Department of Abdominal Surgery, Aarhus University Hospital, Denmark.

Address correspondence to Lone Nikolajsen, MD, PhD, Danish Pain Research Center, Aarhus University Hospital, Norrebrogade 44, Bldg. 1 A, 8000 Aarhus C, Denmark. Address e-mail to nikolajsen{at}dadlnet.dk.

Abstract

BACKGROUND: We examined in this randomized, double-blind study whether a multilevel paravertebral block performed before general anesthesia with propofol and a laryngeal mask enhances postoperative analgesia after breast cancer surgery.

METHODS: Eighty-eight patients were randomized to receive paravertebral injections with either ropivacaine 0.5% (30 mL) or an equivalent amount of isotonic saline. Nine patients were excluded after randomization, thus 79 patients remained for evaluation (ropivacaine, n = 38; placebo, n = 41). Variables of efficacy were the amount of fentanyl delivered by the patient-controlled analgesia device in the postanesthesia care unit (PACU), postoperative pain measured on a numeric rating scale at regular intervals from the day of surgery and until the second postoperative day.

RESULTS: The median consumption of fentanyl in the PACU was less in the ropivacaine group compared with the placebo group (0 µg [range: 0–250 µg] versus 100 µg [range: 0–800 µg], P = 0.001). Also, fewer patients in the ropivacaine group reported pain 3 on the numbers rating scale in the PACU (13 vs 31, P < 0.0001). No statistical difference in pain scores or consumption of analgesics could be demonstrated after discharge from the PACU.

CONCLUSIONS: A multilevel paravertebral block provides good analgesia for breast surgery, but the duration of analgesia is briefer than described in previous studies.

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