Continuous paravertebral block for postoperative pain compared to general anaesthesia and wound infiltration for major oncological breast surgery.

Esther A C Bouman,Alfons Gh Kessels,Maurice Theunissen,Elbert Aj Joosten,Marco Ae Marcus,Hans-Fritz Gramke,Wolfgang F Buhre,Kristien Bmi Keymeulen

doi:10.1186/2193-1801-3-517

Esther A C Bouman, Alfons Gh Kessels + Show 6 more

Open Access

https://doi.org/10.1186/2193-1801-3-517

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Abstract

We hypothesized that improved acute postoperative pain relief will be achieved using general anaesthesia (GA) either in combination with continuous thoracic paravertebral block (GA-cPVB) or single shot (GA-sPVB) as compared to GA supplemented by local wound infiltration (GA-LWI) after unilateral major breast cancer surgery.A randomised controlled trial was conducted in 46 adult women in a day-care or short-stay hospital setting after major breast cancer surgery. Pain-intensity was measured using an 11-point visual analogue scale (VAS) until postoperative day 2. GA-sPVB was stopped due to slow inclusion.No significant difference in VAS score was noted between GA-LWI (VAS median 0.5 (interquartile range 0.18–2.00)) and GA-cPVB, (VAS 0.3 (0.00–1.55, p = 0.195)) 24 hours after surgery or at any point postoperatively until postoperative day 2.We conclude that both GA-LWI and GA-cPVB anaesthetic techniques are equally effective in treatment of acute postoperative pain after major oncological breast surgery. As GA-LWI is easily to perform with fewer complications and it is more cost-effective it should be preferred over GA-cPVB.

Highlights

Optimal acute postoperative pain relief after major surgical breast surgery is still a matter of debate
In daily practice local wound infiltration (LWI) with local anaesthetics is commonly used complementary to systemic analgesics for postoperative pain relief (Johansson et al 2003; Sidiropoulou et al 2008; Vigneau et al 2011)
The present analysis is based on a total of 36 patients: general anaesthesia (GA)-cPVB (n = 18) and GA with LWI (GA-LWI) (n = 18)

Summary

Introduction

Optimal acute postoperative pain relief after major surgical breast surgery is still a matter of debate. Data of our own patient population (Sommer et al 2008) showed that 22% of the patients reported mean VAS of >40 (of a scale 0–100) on the first postoperative day after major breast surgery. This was confirmed in a recent cohort study with a reported mean pain score of 3.82 (SD 2,47) on the postoperative day 1 (Gerbershagen et al 2013; Gerbershagen et al 2014). The use of GA with PVB (GA-PVB) should be compared to GA with LWI (GA-LWI)

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