Analgesic and opioid-sparing effects of single-shot preoperative paravertebral block for radical mastectomy with immediate reconstruction: A retrospective study with propensity-adjusted analysis.
Analgesics
/ administration & dosage
Analgesics, Opioid
/ administration & dosage
Breast Neoplasms
/ pathology
Female
Follow-Up Studies
Humans
Mastectomy
/ adverse effects
Middle Aged
Nerve Block
/ methods
Pain Management
Pain, Postoperative
/ etiology
Postoperative Nausea and Vomiting
/ etiology
Preoperative Care
Prognosis
Retrospective Studies
Breast cancer
Cancer recurrence
Hyperalgesia
Locoregional anesthesia
Pain
Postoperative
Journal
Surgical oncology
ISSN: 1879-3320
Titre abrégé: Surg Oncol
Pays: Netherlands
ID NLM: 9208188
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
31
05
2019
revised:
03
02
2020
accepted:
30
03
2020
entrez:
6
9
2020
pubmed:
7
9
2020
medline:
9
7
2021
Statut:
ppublish
Résumé
Before radical mastectomy with immediate latissimus dorsi flap reconstruction, single-shot paravertebral block (PVB) can be added to general anesthesia to improve analgesia. As this technique was introduced in 2014 in our centre, our aim was to retrospectively assess its clinical effects. Among 175 patients who underwent surgery over four years (40 receiving PVB), we studied the intra-operatively administered doses of opioids and vasopressors, postoperative pain as estimated by a composite score based on the intensity scores for maximum postoperative pain and the amounts of analgesic drugs, and the report of postoperative nausea/vomiting (PONV). The effect of PVB on these outcomes was tested by propensity-matched comparisons, after a propensity score based on the patient's age, body mass index, ASA and Apfel scores, was calculated. Depending on the outcomes, results are expressed as odds ratios (OR) or regression coefficients (RC), with their 95% confidence interval limits. PVB reduced the doses of intraoperative opioids (OR for comparisons between the 2nd and 3rd tercile to the 1st tercile, respectively: 0.39 (0.21; 0.67) and 0.10 (0.05; 0.21)). It increased the doses of intraoperative vasopressors (CR = 1.94 (0.89; 2.93). It reduced the composite score for postoperative pain (CR = -0.80 (-1.04; -0.56), and the occurrence of PONV (OR = 0.21 (0.14; 0.37). Despite a higher risk of intraoperative hypotension, single-shot PVB seems to markedly improve postoperative analgesia and reduce the amounts of opioids. This could offer many clinical advantages in this type of cancer surgery.
Sections du résumé
BACKGROUND
BACKGROUND
Before radical mastectomy with immediate latissimus dorsi flap reconstruction, single-shot paravertebral block (PVB) can be added to general anesthesia to improve analgesia. As this technique was introduced in 2014 in our centre, our aim was to retrospectively assess its clinical effects.
METHODS
METHODS
Among 175 patients who underwent surgery over four years (40 receiving PVB), we studied the intra-operatively administered doses of opioids and vasopressors, postoperative pain as estimated by a composite score based on the intensity scores for maximum postoperative pain and the amounts of analgesic drugs, and the report of postoperative nausea/vomiting (PONV). The effect of PVB on these outcomes was tested by propensity-matched comparisons, after a propensity score based on the patient's age, body mass index, ASA and Apfel scores, was calculated. Depending on the outcomes, results are expressed as odds ratios (OR) or regression coefficients (RC), with their 95% confidence interval limits.
RESULTS
RESULTS
PVB reduced the doses of intraoperative opioids (OR for comparisons between the 2nd and 3rd tercile to the 1st tercile, respectively: 0.39 (0.21; 0.67) and 0.10 (0.05; 0.21)). It increased the doses of intraoperative vasopressors (CR = 1.94 (0.89; 2.93). It reduced the composite score for postoperative pain (CR = -0.80 (-1.04; -0.56), and the occurrence of PONV (OR = 0.21 (0.14; 0.37).
CONCLUSIONS
CONCLUSIONS
Despite a higher risk of intraoperative hypotension, single-shot PVB seems to markedly improve postoperative analgesia and reduce the amounts of opioids. This could offer many clinical advantages in this type of cancer surgery.
Identifiants
pubmed: 32891313
pii: S0960-7404(19)30259-2
doi: 10.1016/j.suronc.2020.03.006
pii:
doi:
Substances chimiques
Analgesics
0
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
103-108Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.