A Prospective Randomized Controlled Trial of paravertebral block versus general anesthesia alone for mastectomy with immediate tissue expander reconstruction: Improving patient pathways
Omer Wolf, MD1, Mark Clemens, MD1, Ronaldo V. Purugganan, MD2, Melissa Crosby, MD1, Jun Liu, MS1, Farzin Goravanchi, MD2.
1Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX, USA, 2Department of Anesthesia, MD Anderson Cancer Center, Houston, TX, USA.
Purpose: Paravertebral Blocks (PVB) have gained popularity due to ease of implementation and a shift towards ambulatory breast surgery procedures. Previous retrospective studies have reported potential benefits of PVB including decrease narcotic and antiemetic use.
Patients and Methods: We conducted a prospective controlled trial for breast patients undergoing immediate tissue expander reconstruction over a two-year period. The patients were randomized to either PVB with general anesthesia versus a control group (CG) of general anesthesia alone. Demographic and procedural data was compared including opioid and antiemetic consumption based upon pain and patient assessment scores.
Results: A total of 73 patients were enrolled either to PVB (n=37) or to CG (n=36). There were no significant differences in ASA score, BMI, age, or axillary surgery between groups. Patients who received a PVB had a non-significant decreased use of opiates and anti-emetics, and reported significantly lower pain scores at 1 (P=0.014) and 3 (P=0.013) hours. Patients who received a PVB were more likely to say they would choose the same anesthesia again (94% PVB versus 87% CG, P=0.0032) and would recommend this type of anesthesia to others (97% versus 90% P=0.0001).
Conclusions: Incorporating paravertebral blocks carries a high potential for improving patient pathways for opiate use and overall satisfaction rate with minimal procedure-related morbidity. This is the first prospective study designed to assess expander breast reconstruction. More research is required to further stratify the type of reconstructive procedures that will most benefit from routine use of PVB.
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