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Abstract
Background This study investigated whether a novel multi-injection intertransverse process block could provide non-inferior analgesia and recovery quality following major breast cancer surgery compared with the multi-injection thoracic paravertebral block.
Methods Eighty-eight females who underwent mastectomy plus sentinel or axillary lymph node dissection were randomized to receive either intertransverse process block or thoracic paravertebral block, both performed at T2–6 with 5 mL of 0.5% ropivacaine per level. The primary outcome was the worst resting pain score (11-point Numerical Rating Scale) within 30 min in the recovery room. The secondary outcome was recovery quality (15-item quality of recovery scale) 24 hours after surgery, which was tested following a gatekeeping procedure.
Results The worst resting pain scores were 0 (0, 1) in the intertransverse process block group vs 0.5 (0, 2) in the thoracic paravertebral block group, with a median difference of 0 (95% CI 0 to 0); the upper 95% CI limit was lower than the prespecified non-inferiority margin of 1 point (non-inferiority p<0.001). Aggregate scores of recovery quality at 24 hours postoperatively were 137.5 (126.5, 142.8) and 137.5 (127.8, 145.0) for the intertransverse process and thoracic paravertebral block groups, respectively, with a median difference of −1 (95% CI −6 to 3); the lower 95% CI limit was larger than the prespecified non-inferiority margin of −8 (non-inferiority p=0.006).
Conclusions Compared with a multi-injection thoracic paravertebral block, the multi-injection intertransverse process block provided non-inferior analgesia within 30 min in the recovery room and recovery quality at 24 hours following major breast cancer surgery in females.
Trial registration number ChiCTR2000037963.
- anesthesia, local
- analgesia
- pain, postoperative
- regional anesthesia
Data availability statement
Data are available on reasonable request.
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Data availability statement
Data are available on reasonable request.
Footnotes
Contributors HZ and LQ are responsible for the overall content as guarantors. We accept full responsibility for the finished work and/or the conduct of the study. HZ: Study design, planning and conduct, data interpretation and critical revision of the manuscript. ZQ: Study design, data collection, data analysis and interpretation. YM: Recruitment of patients and data collection. YZ: Data analysis, data interpretation and manuscript revision. LQ: Study design, planning and conduct, data collection and manuscript drafting. BH: Recruitment of patients. ZH: Data collection and manuscript revision.
Funding This work was supported by National High Level Hospital Clinical Research Funding (No. BJ-2022-136).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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