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

Enhanced recovery after surgery (ERAS) protocols incorporating multimodal analgesia (MMA) have become increasingly popular for breast cancer surgery. Our study evaluated an ERAS approach that combined nonintubated general anesthesia (GA) with thoracic paravertebral block (TPVB) as part of the MMA and compared it with traditional GA. Postoperative outcomes were assessed using numerical rating scale (NRS) pain scores, total analgesic consumption, and postoperative nausea and vomiting (PONV).

We reviewed the medical records of 60 female patients aged 30 to 85 years who underwent unilateral mastectomy with or without sentinel lymph node biopsy (SLNB). Thirty patients received nonintubated GA with a regional block (MMA group), whereas the remaining 30 patients received conventional GA and were matched based on their anesthesia records. Postoperative analgesics, including pethidine and tramadol, were converted into intravenous morphine equivalents. We compared the groups using paired t tests for age, height, weight, operation duration, NRS scores, total analgesic dosage, and the Fisher exact test for PONV rates.

The MMA group showed significantly lower NRS scores ( p < 0.001) and total analgesic consumption ( p < 0.001) than the GA group. Although PONV rates were lower in the MMA group (0% vs 13%, p = 0.112), this difference was not statistically significant, likely due to the effective PONV management in the GA group with dexamethasone or 5-Hydroxytryptamine type 3 (5HT-3) antagonist. There was no significant difference in pain scores ( p = 0.722) or the need for additional analgesics ( p = 0.419) between double- and triple-level TPVB.

Nonintubated GA with total intravenous anesthesia (TIVA) and MMA using TPVB is a viable and safe alternative for breast cancer surgery. It results in reduced pain scores and analgesic needs compared with conventional GA, with PONV outcomes comparable to those managed with standard intravenous medications.