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REGIONAL ANESTHESIA

Single-Injection Paravertebral Block Before General Anesthesia Enhances Analgesia After Breast Cancer Surgery With and Without Associated Lymph Node Biopsy

Pekka M. Kairaluoma, MD^*, Martina S. Bachmann, MD, PhD^*, Aulikki K. Korpinen, MD, Per H. Rosenberg, MD, PhD^*, and Pertti J. Pere, MD, PhD^*

*Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland; and Rheumatism Foundation Hospital, Heinola, Finland

Address correspondence and reprint requests to Pekka M. Kairaluoma, MD, Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, PO Box 580, Helsinki, FIN-00029 HUS, Finland. Address e-mail to pekka.kairaluoma{at}hus.fi

Paravertebral block (PVB) seems to decrease postoperative pain and postoperative nausea and vomiting (PONV) after breast surgery, but the studies have not been placebo controlled. We studied 60 patients scheduled for breast cancer surgery randomly given single-injection PVB at T3 with bupivacaine 5 mg/mL (1.5 mg/kg) or saline before general anesthesia. The patient and attending investigators were blinded; the PVB or the sham block was performed behind a curtain by an anesthesiologist not involved in the study. The patients given PVB with bupivacaine needed 40% less IV opioid medication (primary outcome variable) in the postanesthesia care unit, had a longer latency to the first opioid dose, and had less pain at rest after 24 h than the control patients (P < 0.01). They also had less PONV in the postanesthesia care unit (P < 0.05), were less sedated until 90 min (P < 0.05), and performed better in the digit symbol substitution test at 90 min and the ocular coordination test 60–120 min after surgery (P < 0.05). The average peak bupivacaine plasma concentration was 750 ng/mL. One patient had bilateral convulsions immediately after bupivacaine injection. We conclude that PVB before general anesthesia for breast cancer surgery reduced postoperative pain, opioid consumption, and occurrence of PONV and improved recovery from anesthesia.

IMPLICATIONS: Preoperative single-injection paravertebral block proved a suitable adjunct to a multimodal analgesic regimen: it improved postoperative analgesia and prevented postoperative nausea and vomiting after breast resection or mastectomy with and without associated axillary dissection.

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