Continuous Thoracic Paravertebral Block For Anesthesia And Analgesia In Breast Cancer Surgery

OBJECTIVETo evaluation the effect of continuous thoracic paravertebral nerve block (CPVB) on anesthesia and postoperative analgesia in breast cancer patients.METHODSForty-eight patients scheduled for radical breast cancer surgery were randomly divided into two groups:general anesthesia followed with post-operative patient controlled analgesia (PCIA group,n=24), general anesthesia combined with thoracic paravertebral block (CTPVB group,n=24). Patients in CTPVB group had T3paravertebral nerve block and catheterization before induction. General anesthesia was induced with same regime for both groups, and maintained with sufentanil and propofol infusion titrating BIS to45-60, heart rate(HR) and blood pressure(BP) changing less than±25%of base values. Postoperative pain was controlled with0.25%ropivacain continuous paravertebral thoracic block in the CTPVB group and patient controlled intravenous sufentanil in the PCIA group. Intraoperative hemodynamic changes, sufentanil and propofol dose, time to extubation, PONV of the first24h, pain scores at rest and coughing, sedation scores were compared.RESULTS Blood pressure and heart rate were slightly lower in the CTPVB group during surgery comparing to the PCIA group (P<0.01or P<0.05), but all in clinically normal range. To maintain desired anesthesia, patients in the CTPVB group required smaller sufentanil and propofol dose and were able to be extubated earlier (P<0.01). Postoperative pain were similar at rest between groups but the CTPVB group had lower VAS score at cough (P>0.05). PONV incidence and Ramsay score were lower in the CTPVB group (P<0.05).CONCLUSION(1)MAP and HR during the operation were remained stable in both groups. Thoracic paravertebral block can add perfect analgesia intraoperatively and reduced sufentanil and propofol dose for general anesthesia.(2)Comparing to sufentanil PCIA, CTPVB provided better postoperative pain relieve at cough.(3)CTPVB reduced the incidence of PONV and excessive sedation caused by opioids.