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01-10-2014 | Breast Oncology

Paravertebral Blocks in Patients Undergoing Mastectomy with or without Immediate Reconstruction Provides Improved Pain Control and Decreased Postoperative Nausea and Vomiting

Authors: Aodhnait S. Fahy, BMBCh, PhD, James W. Jakub, MD, Benzon M. Dy, MD, Nora Serag Eldin, MB BCh, Scott Harmsen, MSc, Hans Sviggum, MD, Judy C. Boughey, MD

Published in: Annals of Surgical Oncology | Issue 10/2014

Abstract

Background

Mastectomy is associated with postoperative nausea and pain. We evaluated whether paravertebral block (PVB) use altered opioid use, antiemetic use, and length of stay in patients undergoing mastectomy.

Methods

We performed a retrospective cohort analysis of all patients who underwent mastectomy with or without PVB from 2008 to 2010. Patient demographics, operative procedure, intraoperative medications, postoperative opioid and antiemetic use, and length of stay were reviewed. Statistical analysis included univariable and multivariable analysis.

Results

A total of 605 patients were identified, of whom 526 patients were evaluable. A total of 294 patients underwent mastectomy without PVB (132 bilateral), and 232 patients underwent mastectomy with PVB (148 bilateral). Immediate reconstruction was performed in 203 (39 %) patients. Need for any postoperative antiemetic was less frequent in the PVB group (39 vs. 57 %, p < 0.0001). Day of surgery opioid use was lower in the PVB group than the non-PVB group (mean ± SD 40.1 ± 15.2 vs. 47.6 ± 17.7 morphine equivalents, p < 0.0001). Decreased opioid use was seen in unilateral mastectomy without reconstruction and bilateral mastectomy with and without immediate reconstruction. The proportion of patients discharged within 36 h of surgery was significantly higher in the PVB group (55 vs. 42 %, p = 0.0031). On multivariable analysis controlling for year of surgery, patient age and surgeon, PVB use affected antiemetic use and opioid use but not hospital length of stay.

Conclusions

PVB results in decreased opioid use and decreased need for postoperative antiemetic medication in patients undergoing mastectomy. The greatest benefit is seen in patients undergoing bilateral mastectomy with immediate breast reconstruction.

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Title: Paravertebral Blocks in Patients Undergoing Mastectomy with or without Immediate Reconstruction Provides Improved Pain Control and Decreased Postoperative Nausea and Vomiting
Authors: Aodhnait S. Fahy, BMBCh, PhD
James W. Jakub, MD
Benzon M. Dy, MD
Nora Serag Eldin, MB BCh
Scott Harmsen, MSc
Hans Sviggum, MD
Judy C. Boughey, MD
Publication date: 01-10-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 10/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3923-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Paravertebral Blocks in Patients Undergoing Mastectomy with or without Immediate Reconstruction Provides Improved Pain Control and Decreased Postoperative Nausea and Vomiting

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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