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Paravertebral Catheter for Three-Level Injection in Radical Mastectomy: A Randomised Controlled Study
Petchara Sundarathiti1, Benno von Bormann2, Ronnarat Suvikapakornkul3
1Department of Anaesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Plos One
|June 10, 2015
Summary
Paravertebral block (PVB) with a three-level catheter technique offers effective postoperative pain relief for extensive breast surgery, significantly reducing morphine use compared to general anaesthesia (GA). This method enhances patient safety by avoiding multiple punctures.
Area of Science:
- Anesthesiology
- Surgical Procedures
- Pain Management
Background:
- Paravertebral block (PVB) is an alternative to general anesthesia (GA) for breast surgery.
- Extensive surgeries often require multiple punctures with PVB, increasing risks.
- This study evaluated a novel PVB technique using a catheter with three injections.
Purpose of the Study:
- To assess the efficacy of a three-level paravertebral block (PVB) via catheter for extensive breast surgery.
- To compare postoperative analgesia quality between PVB and general anesthesia (GA).
- To evaluate patient-reported outcomes, including pain, analgesic requirements, and satisfaction.
Main Methods:
- A randomized, single-blind clinical study involving 70 patients undergoing breast surgery.
- Patients were allocated to either GA with sevoflurane or PVB with a catheter at Th4.
- PVB involved sequential 10 ml injections of a bupivacaine/lidocaine mixture at three levels.
Main Results:
- Complication-free catheter insertion was achieved in all PVB patients.
- PVB significantly reduced postoperative morphine consumption (0.26 mg vs. 1.55 mg for GA; p < 0.001).
- Pain scores and readiness for discharge were more favorable with PVB, though PONV and patient satisfaction were comparable.
Conclusions:
- Three-level injection PVB via catheter is an effective and well-accepted technique for extensive mastectomy.
- Utilizing a catheter for PVB can enhance safety by minimizing the need for multiple punctures.
- This approach is beneficial when extended analgesia spread is required.
