Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study

Abstract

Domenico P Santonastaso,1 Annabella de Chiara,1 Emanuele Russo,1 Giovanni Musetti,1 Leonardo Lucchi,2 Andrea Sibilio,3 Roberta Maltoni,4 Emiliano Gamberini,1 Maurizio Fusari,5 Vanni Agnoletti1 1Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena 47521, Italy; 2Day Surgery – Breast Unit, AUSL Romagna, M. Bufalini Hospital, Cesena 47521, Italy; 3General Surgery Unit, AUSL Romagna, Santa Maria delle Croci Hospital, Ravenna 48121, Italy; 4Breast Cancer Unit, Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy; 5Anesthesia and Intensive Care Unit, AUSL Romagna, Santa Maria delle Croci Hospital, Ravenna 48121, ItalyCorrespondence: Domenico P SantonastasoAnesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, Cesena, FC 47521, Italy Tel [phone]Fax [phone]Email [email protected]: General anesthesia (GA) is the most commonly used anesthesiological technique for radical mastectomy operations and can be associated with loco-regional anesthesia techniques. The aim of our study, carried out on 51 patients, was to assess the effectiveness of thoracic paravertebral block (TPVB) associated with GA, or as a sole anesthesiological technique for postoperative pain control and for the reduction of intra and postoperative opioids consumption.Materials and methods: Fifty-one patients with neoplastic breast disease and elected as candidates for radical mastectomy were included in the study. The primary outcomes for this study were intra and postoperative opioid consumption and postoperative pain intensity. In 37 patients, TPVB was associated with GA while in 14 patients it was used as the sole anesthesiological technique. Data are reported as mean with standard deviation median with interquartile range, number, and percentage, depending on the underlying distribution.Results: We did not use intra or postoperative opioids for any patient and the Numeric Rate Scale, assessed at time 0, at the end of the surgery, and 2, 6, 12, and 24 hrs after surgery, was >3 in seven patients only.Conclusions: This study aims to show how TPVB can be used to carry out radical mastectomy procedures so that intra and postoperative opioids use can be avoided. In our study, TPVB was used in total mastectomy procedures in association with GA or as the sole anesthesiological technique, without the intra and postoperative use of opioids and with a significant reduction of local anesthetic dosages compared to those reported in the existing literature.Keywords: thoracic paravertebral block, mastectomy, opioids free anesthesia, awake breast surgery

Keywords

• Thoracic Paravertebral Block Mastectomy Opioids free anesthesia Awake breast surgery