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  • Thoracic Paravertebral Block and Its Effects on Chronic Pain and Health-Related Quality of Life After Modified Radical Mastectomy

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Thoracic Paravertebral Block and Its Effects on Chronic Pain and Health-Related Quality of Life After Modified Radical Mastectomy
  1. Manoj Kumar Karmakar, MD, FRCA, FHKCA, FHKAM*,
  2. Winnie Samy, BN*,
  3. Jia W. Li, PhD*,
  4. Anna Lee, PhD*,
  5. Wing Cheong Chan, FRCSE (Gen)†,
  6. Phoon P. Chen, FANZCA‡ and
  7. Anthony M.-H. Ho, MD*
  1. *Department of Anesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
  2. †Department of Surgery, North District Hospital, Sheung Shui, New Territories, Hong Kong, Special Administrative Region, China
  3. ‡Department of Anaesthesiology and Operating Services, North District Hospital, Sheung Shui, New Territories, Hong Kong, Special Administrative Region, China
  1. Address correspondence to: Manoj Kumar Karmakar, MD, Department of Anesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, 4th Floor-Main Clinical Block and Trauma Centre, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, SAR, China (e-mail: karmakar{at}cuhk.edu.hk).

Abstract

Background and Objectives Patients undergoing breast cancer surgery frequently experience chronic postoperative pain. The primary objective of this randomized study was to determine if thoracic paravertebral block (TPVB) reduced the incidence of chronic pain after a modified radical mastectomy (MRM) when compared with general anesthesia (GA).

Methods One hundred eighty women undergoing MRM were randomized to 1 of 3 study groups: group 1: standardized GA, group 2: GA with a single-injection TPVB and placebo paravertebral infusion, and group 3: GA with a continuous TPVB. Outcomes assessed postoperatively included acute postoperative pain and analgesic consumption and, at 3 and 6 months, the incidence and severity of chronic pain and physical and mental health-related quality of life (HRQOL).

Results There was no significant difference in the incidence of chronic pain at 3 months (P = 0.13) and 6 months (P = 0.79) after the MRM between the study groups. The relative risk of developing chronic pain (P = 0.25) was also similar between the groups. There was no difference in acute pain (P = 0.22) or postoperative analgesic consumption (P = 0.67) between the groups. Nevertheless, differences were observed in chronic pain–related secondary outcome variables. The TPVB groups reported lower chronic pain scores (P < 0.05), exhibited fewer symptoms and signs of chronic pain (P ⩽ 0.01), and also experienced better physical and mental HRQOL than did the GA group. Chronic pain scores also decreased with time in all study groups (P < 0.05).

Conclusions There is no significant difference in the incidence or relative risk of chronic pain at 3 and 6 months after an MRM when TPVB is used in conjunction with GA. Nevertheless, patients who receive a TPVB report less severe chronic pain, exhibit fewer symptoms and signs of chronic pain, and also experience better physical and mental HRQOL.

https://doi.org/10.1097/AAP.0000000000000113

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    Footnotes

    • The authors declare no conflict of interest.

      Dr Ho is now with the Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada.

      Attribute work to the Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.

      This research work was fully funded by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (RGC reference no. CUHK4406/05, project code 2140452).

      Part of this work was presented as a poster discussion at the 36th Annual Regional Anesthesia Meeting and Workshops of the American Society of Regional Anesthesia and Pain Medicine, May 5–8, 2011, Caesars Palace, Las Vegas, Nevada.

      Institutional review board contact information: Joint Chinese University of Hong Kong–New Territories East Cluster Clinical Research Ethics Committee, CREC reference no. CRE-2004.376-T. Contact CRE officer: tel.: +852 2632 3935; fax: +852 2646 6653.