One of the main causes of postoperative complications is general anaesthesia (GA), which is frequently used for sedation and is associated with nausea and vomiting in 50% of the cases.

Alternatives to GA, such as preoperative medications, neuropathic analgesia and local or regional anaesthesia have been explored to reduce postoperative complications and increase perioperative pain control.

Regional anaesthesia is best indicated in patients with a history of chronic neuropathy who present with high opioid consumption before surgery or in patients with significant comorbidity factors in whom reduction of general anaesthetics may be beneficial for their cardiorespiratory function and cerebral function.

Klein et al conducted a randomized prospective study that showed TPVB provided improved analgesia, when compared to GA alone; a decreased vomiting and nausea scores and a decreased opioid consumption registered in the TPVB group.

Other techniques are under investigation as alternatives to or in combination with TPVB. Intra-operative opioid requirements were documented to be lower when a Pecs block was performed, which also reduced postoperative pain scores and opioid consumption. Cali et al believe that the combination of TPVB and peripheral nerve block may result in additional benefits for the patients, especially in terms of reduction of postoperative pain, as opioids consumption and length of hospital stays. Although TPVB cannot reduce the occurrence of relative risk of chronic pain, it can reduce the intensity of chronic pain compared to GA.

According to PROSPECT guideline from 2020, in major breast surgery, a regional anaesthetic technique such as TPVB or Pecs block and/or local anaesthetic wound infiltration may be considered for additional pain relief.

Some studies also suggest that the use of regional anaesthesia-analgesia could attenuate perioperative immunosuppression and minimize metastases in breast cancer patients.

References

1. Jacobs A, Lemoine A, Joshi GP, Van de Velde M, Bonnet F, PROSPECT Working Group collaborators# PROSPECT guideline for oncological breast surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020 May;75(5):664–673.

2. Calì Cassi L, Biffoli F, Francesconi D, Petrella G, Buonomo O. Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block. Eur Rev Med Pharmacol Sci 2017;21(6):1341–1345.

3. Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 2009;302:1985–1992.

4. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg 2000;90:1402–1405.