Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-18T13:53:37.007Z Has data issue: false hasContentIssue false
  • English
  • Français

Nerve-stimulator guided paravertebral blockade vs. general anaesthesia for breast surgery: a prospective randomized trial

Published online by Cambridge University Press:  11 July 2005

M. Z. Naja ,
M. F. Ziade  and
P. A. Lönnqvist
M. Z. Naja
Affiliation:
Makassed General Hospital, Department of Anesthesia and Intensive care, Beirut, Lebanon
M. F. Ziade
Affiliation:
Lebanese University, Faculty of Public Health, Beirut, Lebanon
P. A. Lönnqvist
Affiliation:
KS/Astrid Lindgren Children's Hospital, Department of Anesthesia and Intensive Care, Stockholm, Sweden
Get access

Abstract

Summary

Background and objective: Different anaesthetic techniques are used during breast surgery but are frequently associated with unsatisfactory postoperative analgesia. Paravertebral nerve blockade has recently been proposed as a favourable alternative for this type of surgical procedure, providing excellent pain relief and a reduced incidence of postoperative nausea and vomiting. The aim of the present study was to compare the use of a nerve-stimulator guided paravertebral nerve blockade technique to regular general anaesthesia for breast surgery.

Methods: Sixty patients were prospectively randomized to receive either paravertebral nerve blockade or general anaesthesia for breast surgery. The primary end-point of the study was to assess postoperative analgesia (visual analogue scale and supplemental opioid requirements); the incidence of postoperative nausea and vomiting and length of hospital stay were considered as secondary outcome measures.

Results: Visual analogue scores both at rest and at movement, as well as the need for supplemental opioid administration during the first 3 days postoperatively, were significantly lower in patients handled with paravertebral nerve blockade compared to patients receiving general anaesthesia (P < 0.05). The number of patients free from nausea and vomiting after operation was significantly higher in the paravertebral nerve blockade group (93%) compared to the general anaesthesia group (67%) (P < 0.05). The use of paravertebral nerve blockade was also associated with a significantly shorter hospital stay (median 1 day) compared to general anaesthesia (2 days) (P < 0.01). Both the performance of the block and the intraoperative conditions was well accepted by the vast majority of patients treated by paravertebral nerve blockade (97%).

Conclusion: The use of paravertebral nerve blockade was associated with improved postoperative pain relief, a reduced incidence of nausea and vomiting after operation and a shorter duration of hospital stay compared to general anaesthesia in patients undergoing breast surgery.

Keywords

ANAESTHESIA, CONDUCTION, nerve block, paravertebralBREAST DISEASES, breast neoplasmsPOSTOPERATIVE COMPLICATIONS, postoperative nausea and vomitingSURGERY, breast
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 11 , November 2003 , pp. 897 - 903
Copyright
2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jaffe SM, Campbell P, Bellman M, Baildam A. Postoperative nausea and vomiting in women following breast surgery: an audit. Eur J Anaesthesiol 2000; 17: 261–264.Google Scholar
Oddby-Muhrbeck E, Jakobsson J, Andersson, Askergren J, Lönnqvist PA. Effects of clonidine on postoperative nausea and vomiting in breast cancer surgery. Anesthesiology 2002; 96: 1109–1114.Google Scholar
Gan TJ, Ginsberg B, Grant AP, Glass PS. Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting. Anesthesiology 1996; 85: 1036–1042.Google Scholar
Fujii Y, Tanaka H, Toyooka H. Prophylactic antiemetic therapy with granisetron-dexamethasone combination in women undergoing breast surgery. Acta Anaesthesiol Scand 1998; 42: 1038–1042.Google Scholar
Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 1995; 6: 453–459.Google Scholar
Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single- injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand 1999; 43: 770–774.Google Scholar
Greengrass R, O'Brien F, Lyerly K, et al. Pravertebral block for breast cancer surgery. Can J Anesth 1996; 43: 858–861.Google Scholar
Coveney E, Weltz CR, Greengrass R, et al. Use of paravertebral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Ann Surg 1998; 227: 496–501.Google Scholar
Oakley N, Dennison AR, Shorthouse AJ. A prospective audit of simple mastectomy under local anaesthesia. Eur J Surg Oncol 1996; 22: 134–136.Google Scholar
Dennison AR, Watkins RM, Ward ME, Lee EC. Simple mastectomy under local anaesthesia. Ann R Coll Surg Engl 1985: 67: 243–244.Google Scholar
Pettersson N, Perbeck L, Hahn RG. Efficacy of subcutaneous and topical local anaesthesia for pain relief after resection of malignant breast tumours. Eur J Surg 2001; 167: 825–830.Google Scholar
Weltz CR, Greengrass RA, Lyerly HK. Ambulatory surgical management of breast carcinoma using paravertebral block. Ann Surg 1995; 222: 19–26.Google Scholar
Lönnqvist PA, Mackenzie J, Soni AK, Conacher ID. Paravertebral blockade. Failure rate and complications. Anaesthesia 1995; 50: 813–815.Google Scholar
Richardson J, Lonnqvist PA. Thoracic paravertebral block. Br J Anaesth 1998; 81: 230–238.Google Scholar
Richardson J, Cheema SP, Hawkins J, Sabanathan S. Thoracic paravertebral space location. A new method using pressure measurement. Anaesthesia 1996; 51: 137–139.Google Scholar
Jonathan CM. Continuous paravertebral block in children. Anaesthesia 1993; 48: 93.Google Scholar
Eason MJ, Wyatt R. Paravertebral thoracic block-a reappraisal. Anaesthesia 1979; 34: 638–642.Google Scholar
Naja Z, Lönnqvist PA. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia 2001; 56: 1184–1188.Google Scholar
Tighe SQM. Paravertebral block. Anaesthesia 2002; 57: 511–512.Google Scholar
Naja Z, el Hassan MJ, Khatib H, Ziade MF, Lönnqvist PA. Combined sciatic-paravertebral nerve block vs. general anaesthesia for fractured hip of the elderly. Mid East J Anesthesiol 2000; 15: 559–568.Google Scholar
Naja Z, Ziade MF, Lönnqvist PA. Bilateral paravertebral somatic nerve block for ventral hernia repair. Eur J Anaesthesiol 2002; 19: 197–202.Google Scholar
Naja MZ, el Hassan MJ, Oweidat M, Zbibo R, Ziade MF, Lonnqvist PA. Paravertebral blockade vs general anesthesia or spinal anesthesia for inguinal hernia repair. Mid East J Anesthesiol 2001; 16: 201–210.Google Scholar
Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anesthesia improves outcome after breast surgery. Ann Surg 1995; 222: 663–669.Google Scholar
Richardson J, Sabanathan S. Thoracic paravertebral analgesia. Acta Anaesthesiol Scand 1995; 39: 1005–1015.Google Scholar
Richardson J, Lönnqvist PA. Thoracic paravertebral block. Brit J Anaesth 1998; 81: 230–238.Google Scholar
Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001; 95: 771–780.Google Scholar
Richardson J, Jones J, Atkinson R. The effect of thoracic paravertebral blockade on intercostal somatosensor evoked potentials. Anesth Analg 1998; 87: 373–376.Google Scholar
Bernard JM, Macaire P. Dose-range effects of clonidine added to lidocaine for brachial plexus block. Anesthesiology 1997; 87: 277–284.Google Scholar
El Saied AH, Steyn MP, Ansermino JM. Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Can J Anesth 2000; 47: 962–967.Google Scholar
Singelyn FJ, Gouverneur JM, Robert A. A minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Anesth Analg 1996; 83: 1046–1050.Google Scholar
Elhakim M, Abdul Salam AY, Eid A, Kaschef N, Mostafa BE. Inclusion of pethidine in lidocaine for infiltration improves analgesia following tonsillectomy in children. Acta Anaesthesiol Scand 1997; 41: 214–217.Google Scholar
Arendt-Nielsen L, Bjerring P, Dahl JB. A quantitative double-blind evaluation of the antinociceptive effects of perineurally administered morphine compared with lidocaine. Acta Anaesthesiol Scand 1991; 35: 24–29.Google Scholar
Allen GC, St Amand MA, Lui AC, Johnson DH, Lindsay MP. Postarthroscopy analgesia with intraarticular bupivacaine/morphine. A randomized clinical trial. Anesthesiology 1993; 79: 475–480.Google Scholar
Sanchez R, Nielsen H, Heslet L, Iversen AD. Neuronal blockade with morphine. A hypothesis. Anaesthesia 1984; 39: 788–789.Google Scholar
Mays KS, Lipman JJ, Schnapp M. Local analgesia without anesthesia using peripheral perineural morphine injections. Anesth Analg 1987; 66: 417–420.Google Scholar
Giannoni C, White S, Enneking FK, Morey T. Ropivacaine with or without clonidine improves pediatric tonsillectomy pain. Arch Otolaryngol Head Neck Surg 2001; 127: 1265–1270.Google Scholar
Richardson J, Sabanathan S, Jones J, Shah RD, Cheema S, Mearns AJ. A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. Br J Anaesth 1999; 83: 387–392.Google Scholar
Saito T, Den S, Cheema SP, et al. A single-injection, multi-segmental paravertebral block-extension of somatosensory and sympathetic block in volunteers. Acta Anaesthesiol Scand 2001; 45: 30–33.Google Scholar