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Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery
  1. Hakim Harkouk1,2,
  2. Dominique Fletcher1 and
  3. Valeria Martinez3
  1. 1Anesthesia department, Hopital Ambroise-Paré, Boulogne-Billancourt, France
  2. 2INSERM U987, INSERM, Paris, France
  3. 3Anesthesia department, Hôpital Raymond-Poincaré, Garches, France
  1. Correspondence to Dr Hakim Harkouk, Anesthesia, Hopital Ambroise-Pare, Boulogne-Billancourt 92104, France; hakim.harkouk{at}aphp.fr

Abstract

Patients frequently report chronic postsurgical pain (CPSP) after breast cancer surgery (BCS). The paravertebral block (PVB) is an effective technique to reduce acute postoperative pain after BCS, but its efficacy in preventing CPSP is unclear. This meta-analysis evaluates the efficacy of PVB in preventing CPSP after BCS. We searched Medline, Embase, CENTRAL, Database of Abstracts of Reviews of Effects, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for studies comparing PVB with control for CPSP prevention after BCS, from inception to April 2020. The primary outcome was CPSP at 6 months, and the secondary outcomes were CPSP at 3 and 12 months, chronic postsurgical neuropathic pain (CPSNP) at 6 months, and PVB-related complications. Data were pooled and analyzed with a random-effects model, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate the certainty of evidence. A total of 12 studies were included in the study; data for the 6-month time point from 7 studies (2161 patients) were analyzed, and no difference was found between PVB and control in terms of efficacy in preventing CPSP after BCS (risk ratio (RR) 0.82 (95% CI 0.62 to 1.08)), with a moderate quality of evidence according to the GRADE system. Similar results were obtained at 3 and 12 months (RR 0.78 (95% CI 0.57 to 1.06), RR 0.45 (95% CI 0.14 to 1.41), respectively). Data for the 12-month time point from seven studies (2087 patients) were analyzed and showed that PVB protected against CPSNP, with low quality of evidence (RR 0.51 (95% CI 0.31 to 0.85)). In conclusion, CPSP was not found significantly prevented by PVB after BCS despite the limits in the included studies; nevertheless, PVB could prevent CPSNP by impacting the transition from acute to chronic pain.

  • analgesia
  • chronic pain
  • pain
  • postoperative
  • regional anesthesia
  • nerve block
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Footnotes

  • Contributors HH contributed to the implementation of the research, analysis of the results, and writing of the manuscript. DF helped in the analysis of the results and in writing the manuscript. VM contributed to the design and implementation of the research, analysis of the results, and writing of the manuscript.

  • Funding This work received support from the EU/EFPIA/Innovative Medicines Initiative (2) Joint Undertaking (IMI-PAINCARE) (grant no. 777500).

  • Disclaimer The statements and opinions presented here reflect the authors’ view, and neither IMI nor the European Union, EFPIA, or any associated partners are responsible for any use that may be made of the information contained herein (www.imi.europa.eu; www.imi-paincare.eu).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Protocol and supplemental data are available upon request.

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