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Comparison of single-injection ultrasound-guided approach versus multilevel landmark-based approach for thoracic paravertebral blockade for breast tumor resection: a retrospective analysis at a tertiary care teaching institution

Authors Saran JS, Hoefnagel AL, Skinner KA, Feng C, Smith DI

Received 2 March 2017

Accepted for publication 12 April 2017

Published 28 June 2017 Volume 2017:10 Pages 1487—1492

DOI https://doi.org/10.2147/JPR.S135973

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon

Jagroop Singh Saran,1 Amie L Hoefnagel,1 Kristin A Skinner,2 Changyong Feng,3 Daryl Irving Smith1

1Acute Pain Service, Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 2Department of Surgical Oncology, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, 3Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

Background: The role of thoracic paravertebral blockade (TPVB) in decreasing opioid requirements in breast cancer surgery is well documented, and there is mounting evidence that this may improve survival and reduce the rate of malignancy recurrence following cancer-related mastectomy. We compared the two techniques currently in use at our institution, the anatomic landmark-guided (ALG) multilevel versus an ultrasound-guided (USG) single injection, to determine an optimal technique.
Methods: We retrospectively reviewed records of patients who received TPVB from January 2013 to December 2014. Perioperative opioid use, post anesthesia care unit (PACU) pain scores and length of stay, block performance, and complications were compared between the two groups.
Results: We found no statistical difference between the two approaches in the studied outcomes. We did find that the number of times attending physicians in the ALG group took over the blocks from residents was significantly greater than that of the USG group (p=0.006) and more local anesthetic was used in the USG group (p=0.04).
Conclusion: This study compared the ALG approach with the USG approach for patients undergoing mastectomy for breast cancer. Based on our observations, an attending physician is more likely to take over an ALG injection, and more local anesthetic is administered during USG single injection.

Keywords: thoracic paravertebral block, regional anesthesia, mastectomy, breast cancer
 

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