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AMBULATORY ANESTHESIA

Paravertebral Blockade for Minor Breast Surgery

Michel A. Terheggen, MD^*, Frank Wille, MD, Inne H. Borel Rinkes, MD, PhD, Trian I. Ionescu, MD, PhD, and Johannes T. Knape, MD, PhD

*Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands; Department of Anesthesiology, Diakonessenhuis, Utrecht/Zeist, The Netherlands; Division for Perioperative Care, Anesthesia and Pain Medicine, University Medical Center, Utrecht, The Netherlands; and Department of Surgery, University Medical Center Utrecht, The Netherlands

Address correspondence and reprint requests to Michel A. M. B. Terheggen, Department of Anesthesiology, Ziekenhuis Rijnstate, Postbus 9555, 6800 TA Arnhem, the Netherlands. Address e-mail to mterhegg{at}euronet.nl

Paravertebral blockade (PVB) has been advocated as a useful technique for breast surgery. We prospectively compared the efficacy of PVB via a catheter technique with the efficacy of general anesthesia (GA) for minor breast surgery. Thirty patients were randomized into two groups to receive either PVB or GA. Variables of efficacy were postoperative pain measured on a visual analog scale, postoperative nausea and vomiting (PONV), recovery time, and patient satisfaction. Postoperative visual analog scale scores in the PVB group were significantly lower in the early postoperative period (maximum, 12 vs 45 mm; P < 0.01). In both groups, PONV was nearly absent. There was no difference in recovery time. Patient satisfaction was better in the PVB group (2.8 vs 2.3; scale, 0–3; P < 0.01). There was one inadvertent epidural block and one inadvertent pleural puncture in the PVB group. Although PVB resulted in better postoperative pain relief, the advantages over GA were marginal in this patient group because postoperative pain was relatively mild and the incidence of PONV was small. Considering that the technique has a certain complication rate, we conclude that at present the risk/benefit ratio of PVB does not favor routine use for minor breast surgery.

IMPLICATIONS: This study confirms the previously reported superior pain relief after paravertebral blockade (PVB) for breast surgery. However, considering the relatively mild postoperative pain and therefore the limited advantage of PVB for these patients, the risk/benefit ratio does not favor the routine use of PVB for minor breast surgery.

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