Paravertebral block for breast surgery: a cost analysis.

Abstract

Abstract Abstract #6103 Background: Paravertebral block (PVB) is a form of regional block that has long been used in surgical procedures, including breast surgery. PVB provides intraoperative and postoperative analgesia, decreasing the need for narcotics (NA). It also decreases amounts of general anesthesia (GA) required. NA and GA contribute to postoperative nausea and vomiting, which is decreased with PVB. There has not been a modern cost analysis of PVB in breast surgery. The purpose of this study is to evaluate patient comfort and cost effectivness of PVB in breast surgery.
 Materials and Methods: A retrospective chart review of 461 breast cases was performed. Mastectomy with or without axillary staging and lumpectomy with axillary staging were included (n=188). Minor breast biopsies, lumpectomies alone, and combined reconstructions/other procedures were excluded. Data collected included whether or not PVB was performed (based on surgeon/patient/anesthesiologist preference), length of stay (LOS), postoperative requirements for NA and antiemetics (AE), and complications from PVB. Patients (pts) were scheduled as inpatient (IP) or outpatient (OP) based on procedure and comorbidities. The data was analyzed for IP and OP groups for LOS. Cost was calculated from NA and AE use and overnight stay.
 Results: 188 total procedures (125 IP; 63 OP). 88/125 IP had PVB (70%). 57/63 OP had PVB (90%). IP LOS < 24 hrs had 4/5 with PVB (80%); 1/5 without (20%). LOS 24-36 hrs had 46/63 with PVB (73%); 17/63 without (27%). 57 had LOS > 36 hrs; 38/57 with PVB (67%); 19/57 without (33%). OP LOS 0-2 hrs had 41 pts; 39/41 with PVB (95%); 2/41 without (5%). 22 had LOS > 2 hrs; 18/22 with PVB (82%); 4/22 without (18%). There was an overall shorter LOS for both IP and OP with PVB than without (p=0.0151). 152/188 pts required NA (81%). 112/152 received PVB (74%); 40/152 did not (26%). 36/188 did not require NA (19%). 32/36 received PVB (89%); 4/36 did not (11%). There was a difference between those who did and did not receive PVB and NA use (p=0.0257). 86/188 required antiemetics (46%). 59/86 received PVB (69%); 27/86 did not (31%). 102/188 did not require AE (54%). 86/102 received PVB (84%); 16/102 did not (16%). There was a difference between those who did and did not receive PVB and requirements for AE (p=0.0143). Number of doses of NA and AE were summarized as cost values per pt. The average cost for these medications for an IP with PVB was $184 vs $213 without. OP medicine costs with and without PVB was $39 and $111. Overall average cost difference was $29 for IP, $72 for OP. OP also saved $800 overnight charge. For all pts combined, there was a statistical cost difference (p=0.0085). 1/188 pts had a complication (pneumothorax).
 Discussion: PVB results in less use of postoperative NA and AE in breast surgery. Not only is this reflected in pt comfort, but also a statistically significant cost reduction for both IP and OP procedures and LOS. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6103.