A Prospective, Randomized, Controlled Trial of Paravertebral Block versus General Anesthesia Alone for Prosthetic Breast Reconstruction. Issue 4 (April 2016)

• Record Type: Journal Article
• Authors: Wolf, Omer; Clemens, Mark W.; Purugganan, Ronaldo V.; Crosby, Melissa A.; Kowalski, Alicia M.; Kee, Spencer S.; Liu, Jun; Goravanchi, Farzin
• Is Part Of: Plastic and reconstructive surgery. Volume 137:Issue 4(2016:Apr.)
• Publication Date: 2016-04
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/01.prs.0000481070.79186.0d
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: Paravertebral blocks have gained popularity because of ease of implementation and a shift toward ambulatory breast surgery procedures. Previous retrospective studies have reported potential benefits of paravertebral blocks, including decreased narcotic and antiemetic use. Methods: The authors conducted a prospective controlled trial of patients undergoing breast reconstruction over a 3-year period. The patients were randomized to either a study group of paravertebral blocks with general anesthesia or a control group of general anesthesia alone. Demographic and procedural data, in addition to data regarding pain and nausea patient-reported numeric scores and consumption of opioid and antiemetic medications, were recorded. Results: A total of 74 patients were enrolled to either the paravertebral block ( n = 35) or the control group ( n = 39). There were no significant differences in age, body mass index, procedure type, or cancer diagnosis between the two groups. Patients who received a paravertebral block required less opioid intraoperatively and postoperatively combined compared with patients who did not receive paravertebral blocks (109 versus 246 fentanyl equivalent units; p < 0.001), and reported significantly lower pain scores at 0 to 1 (3.0 versus 4.6; p = 0.02), 1 to 3 (2.0 versus 3.2; p = 0.01), and 3 to 6 (1.9 versus 2.7; p = 0.04) hours postoperatively. The study group also consumed less antiemetic medication (0.7 versus 2.1; p = 0.05). Conclusions: Incorporating paravertebral blocks carries considerable potential for improving pathways for breast cancer patients undergoing breast reconstruction—with minimal procedure-related morbidity. This is the first prospective study designed to assess paravertebral blocks in the setting of prosthetic breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.