Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized,Controlled, Single-Center Trial |
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| Authors: | Lijian Pei Yidong Zhou Gang Tan Feng Mao Dongsheng Yang Jinghong Guan Yan Lin Xuejing Wang Yanna Zhang Xiaohui Zhang Songjie Shen Zhonghuang Xu Qiang Sun Yuguang Huang The Outcomes Research Consortium |
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| Institution: | 1. Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, PR China.; 2. Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, PR China.; 3. Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, United States of America.; ACTREC (Advanced Centre for Treatment, Research and Education in Cancer) / Tata Memorial Centre, INDIA, |
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| Abstract: | ObjectivesThe contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery.MethodsPatients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121) or fentanyl with sevoflurane general anesthesia (GA group, n = 126). Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests.ResultsPatients in the PPA group required less sevoflurane than those in the GA group (median interquartile range] of 0 0, 0] vs. 0.4 0.3, 0.6] minimum alveolar concentration MAC]-hours), less intraoperative fentanyl requirements (100 50, 100] vs. 250 200, 300]μg,), less intense postoperative pain (median visual analog scale score 2 1, 3.5] vs. 3 2, 4.5]), but more propofol (median 529 424, 672] vs. 100 100, 130] mg). Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions.ConclusionsThe combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery.Trial RegistrationClinicalTrial.gov NCT00418457 |
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