@article {Zhangrapm-2022-104003, author = {Hongye Zhang and Zongyang Qu and Yongsheng Miao and Yuelun Zhang and Lulu Qian and Bin Hua and Zhen Hua}, title = {Comparison between ultrasound-guided multi-injection intertransverse process and thoracic paravertebral blocks for major breast cancer surgery: a randomized non-inferiority trial}, elocation-id = {rapm-2022-104003}, year = {2022}, doi = {10.1136/rapm-2022-104003}, publisher = {BMJ Specialist Journals}, 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{\textendash}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.Data are available on reasonable request.}, issn = {1098-7339}, URL = {https://rapm.bmj.com/content/early/2022/12/14/rapm-2022-104003}, eprint = {https://rapm.bmj.com/content/early/2022/12/14/rapm-2022-104003.full.pdf}, journal = {Regional Anesthesia \& Pain Medicine} }