Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial L’anesthésie régionale paravertébrale thoracique améliore l’analgésie après chirurgie pour cancer du sein: essai clinique

Background The contribution of regional anesthesia with thoracic paravertebral blockade to postoperative analgesia remains unclear. We compared the effect of a combination of paravertebral blockade and propofol general anesthesia (GA) with sevoflurane GA and opioid analgesia on postoperative pain and opioid use for patients undergoing breast cancer surgery. Methods Patients having breast cancer surgery were randomly assigned to paravertebral analgesia with propofol GA (PPA, n = 187) or sevoflurane GA with perioperative opioid analgesia (SOA, n = 199). The PPA and SOA groups were compared for opioid consumption and pain outcomes (on a 0-10 visual analogue scale [VAS]) at two hours postoperatively using superiority and inferiority statistics. We compared our results with previous publications in a meta-analysis. Results Compared with the SOA group, the PPA group experienced reduced median [interquartile range] pain VAS scores (1 [1,3] vs 2.5 [1,4], respectively; median difference -1.0; 99% confidence intervals [CI]: -1.5 to -0.5) and required less intraoperative fentanyl (50 [0, 125] lg vs 200 [100, 300] lg, respectively; median difference -100; 99% CI: -150 to -100) and less longacting opioid (0 [0, 0] mg vs 3.0 [0, 12] mg, respectively, morphine equivalents; median difference -3; 99% CI: -4 to -2). Thus, non-inferiority was detected for all the above outcomes, and superiority tests for each outcome were highly significant in the expected directions (P \ 0.001). Meta-analysis, including the current study, estimated a reduction in worst pain of 2.3 points (95% CI: 1.8 to 2.8) on a 0-10 scale and a 72% reduction (95% CI: 42 to 87) in Author contributions Jiang Wu, Donald J. Buggy, Edith Fleischmann, Ivan Parra-Sanchez, Tanja Treschan, and Andrea Kurz contributed substantially to the acquisition of data. Jiang Wu, Donald J. Buggy, Edith Fleischmann, Ivan Parra-Sanchez, Tanja Treschan, Andrea Kurz, Edward J. Mascha, and Daniel I. Sessler contributed substantially to the interpretation of data. Donald J. Buggy, Edith Fleischmann, Ivan Parra-Sanchez, Tanja Treschan, Andrea Kurz, and Edward J. Mascha contributed to the analysis of data. Donald J. Buggy and Daniel I. Sessler contributed substantially to the conception and design of the manuscript. Donald J. Buggy, Jiang Wu, and Daniel I. Sessler drafted the article. J. Wu, MD ! I. Parra-Sanchez, MD Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA D. Buggy, MD (&) Department of Anaesthesia, Mater Misericordiae University Hospital, National Cancer Screening Service & University College Dublin, Dublin 7, Ireland e-mail: [email protected] E. Fleischmann, MD Department of Anesthesiology and Intensive Care, Medical University Vienna, Vienna, Austria T. Treschan, MD Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany A. Kurz, MD ! D. I. Sessler, MD Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA E. J. Mascha, PhD Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA 123 Can J Anesth/J Can Anesth (2015) 62:241–251 DOI 10.1007/s12630-014-0285-8