Multimodal analgesia with thoracic paravertebral block decrease pain and side effects in mastectomy patients

Area of Science:

• Anesthesiology
• Surgical Oncology
• Pain Management

Background:

• Enhanced Recovery After Surgery (ERAS) protocols are increasingly adopted for breast cancer surgery.
• Multimodal analgesia (MMA) is a key component of ERAS, aiming to optimize pain control.
• This study investigates a specific ERAS approach combining nonintubated general anesthesia (GA) with thoracic paravertebral block (TPVB) for MMA.

Purpose of the Study:

• To evaluate the efficacy of an ERAS protocol using nonintubated GA with TPVB-based MMA.
• To compare postoperative outcomes, including pain scores, analgesic consumption, and PONV, with traditional GA.
• To assess the safety and viability of this combined anesthetic technique for breast cancer surgery.

Main Methods:

• Retrospective review of 60 female patients undergoing unilateral mastectomy with or without SLNB.
• Comparison between 30 patients receiving nonintubated GA with TPVB (MMA group) and 30 patients receiving conventional GA.
• Analysis of numerical rating scale (NRS) pain scores, total analgesic consumption (converted to morphine equivalents), and postoperative nausea and vomiting (PONV) rates.

Main Results:

• The MMA group demonstrated significantly lower NRS pain scores (p < 0.001) and reduced total analgesic consumption (p < 0.001) compared to the conventional GA group.
• Postoperative nausea and vomiting (PONV) rates were lower in the MMA group (0% vs. 13%), though not statistically significant (p = 0.112).
• No significant difference in pain scores or need for additional analgesics was observed between double- and triple-level TPVB.

Conclusions:

• Nonintubated general anesthesia (GA) combined with total intravenous anesthesia (TIVA) and MMA utilizing thoracic paravertebral block (TPVB) is a safe and effective alternative for breast cancer surgery.
• This ERAS approach leads to decreased postoperative pain and analgesic requirements compared to conventional GA.
• PONV outcomes are comparable between the investigated ERAS protocol and standard intravenous pain management strategies.