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01-04-2013 | Breast Oncology

Use of Preoperative Paravertebral Block Decreases Length of Stay in Patients Undergoing Mastectomy Plus Immediate Reconstruction

Authors: Suzanne B. Coopey, MD, Michelle C. Specht, MD, Lisa Warren, MD, Barbara L. Smith, MD, PhD, Jonathan M. Winograd, MD, Katharine Fleischmann, MD

Published in: Annals of Surgical Oncology | Issue 4/2013

Abstract

Background

A prior study in patients undergoing breast surgery with and without the use of paravertebral blocks (PVB) found no significant difference in patient length of stay (LOS). However, patients undergoing bilateral procedures and those undergoing immediate reconstructions were excluded. We sought to determine if the use of PVB in patients undergoing unilateral or bilateral mastectomy plus immediate reconstruction decreases patient LOS.

Methods

We undertook a retrospective review of patients who had mastectomies with immediate reconstructions with and without the use of preoperative PVB. Outcomes including LOS, postoperative nausea and vomiting, and time to oral narcotics were compared between groups.

Results

Mean LOS for the PVB group was 42 h. This was significantly less than the mean LOS of 47 h for the nonblock group (p = .0015). The significantly lower LOS for the PVB group was true for patients undergoing bilateral procedures (p = .045), unilateral procedures (p = .0031), tissue expander placement (p = .0114), and immediate implant placement (p = .037). Mean time to conversion to oral narcotics was significantly shorter in the PVB group (15 h) compared with the nonblock group (20 h) (p < .001). The incidence of postoperative nausea in the PVB group (42.8 %) was also significantly less than in the nonblock group (54.7 %) (p = .031).

Conclusions

The routine use of preoperative PVB in patients undergoing mastectomy plus immediate reconstruction significantly decreased patient LOS. In addition to improved pain control from the block itself, quicker conversion to oral narcotics because of less postoperative nausea likely contributed to a decreased LOS.

American Cancer Society. Breast Cancer Facts and Figures. http://www.canc<AP>er.org/Research/CancerFactsFigures/BreastCancerFactsFigures. Accessed 2 April 2012.

Arriagada R, Le MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol. 1996;14:1558–64.PubMed

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year followup of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRef

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRef

NIH Consensus Conference. Treatment of early-stage breast cancer. JAMA. 1991;265:391–5.CrossRef

Lazovich D, Solomon CC, Thomas DB, Moe RE, White E. Breast Conservation Therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the Treatment of Patients with Early Stage Invasive Breast Carcinoma. Cancer. 1999;86: 628–37.PubMedCrossRef

Habermann EB, Abbott A, Parsons HM, Virnig BA, Al-Refaie WB, Tuttle TM. Are mastectomy rates really increasing in the United States? J Clin Oncol. 2010;28:3437–41.PubMedCrossRef

Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25:5203–9.PubMedCrossRef

Sisco M, Du H, Gutowski KA, Song DH, Winchester DJ, Yao K, et al. Have We Expanded the Equitable Delivery of Postmastectomy Reconstruction in the New Millennium? Evidence from the National Cancer Database [abstract]. Reference Number SP2011-14901. American College of Surgeons Clinical Congress, 2011.

10.

Weltz CR, Greengrass RA, Lyerly HK. Ambulatory surgical management of breast carcinoma using paravertebral block. Ann Surg.1995;222:19–26.PubMedCrossRef

11.

Boughey JC, Goravanchi F, Parris RN, Kee SS, Kowalski AM, Frenzel JC, et al. Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery. Am J Surg. 2009;198:720–5.PubMedCrossRef

12.

Boughey JC, Goravanchi F, Parris RN, Kee SS, Frenzel JC, Hunt KK, et al. Improved postoperative pain control using thoracic paravertebral block for breast operations. Breast J. 2009;15:483–8.PubMedCrossRef

13.

Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ. Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy. Anesth Analg. 2004;99:1837–43.PubMedCrossRef

14.

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;43:770–4.PubMedCrossRef

15.

Terheggen MA, Wille F, Borel Rinkes IH, Ionescu TI, Knape JT. Paravertebral blockade for minor breast surgery. Anesth Analg. 2002;94:355–9.PubMed

16.

Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2010;105:842–52.PubMedCrossRef

17.

Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carlsson PS. Thoracic paravertebral block for breast cancer surgery: a randomized double-blind study. Anesth Analg. 2007;105:1848–51.PubMedCrossRef

18.

Sidiropoulou T, Buonomo O, Fabbi E, Silvi MB, Kostopanagiotou G, Sabato AF, et al. A prospective comparison of continuous wound infiltration with ropivacaine versus single-injection paravertebral block after modified radical mastectomy. Anesth Analg. 2008;106:997–1001.PubMedCrossRef

19.

Kitowski NJ, Landercasper J, Gundrum JD, De Maiffe BM, Chestnut DH, Bottcher ML, et al. Local and paravertebral block anesthesia for outpatient elective breast cancer surgery. Arch Surg. 2010;145:592–4.PubMedCrossRef

Title: Use of Preoperative Paravertebral Block Decreases Length of Stay in Patients Undergoing Mastectomy Plus Immediate Reconstruction
Authors: Suzanne B. Coopey, MD
Michelle C. Specht, MD
Lisa Warren, MD
Barbara L. Smith, MD, PhD
Jonathan M. Winograd, MD
Katharine Fleischmann, MD
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 4/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2678-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Use of Preoperative Paravertebral Block Decreases Length of Stay in Patients Undergoing Mastectomy Plus Immediate Reconstruction

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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