Paravertebral Block for Post-Operative Analgesia after Breast Cancer Surgery, Effects of Adding Morphine: Double Blind, Randomised Clinical Trial

Gudmundur Björnsson, Astridur Johannesdottir, Bjarni Valtysson, Gisli H. Sigurdsson

Department of Anaesthesiology and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland.
Orkuhúsid Clinic, Rey- kjavik, Iceland.

DOI: 10.4236/ojanes.2013.32028                

Abstract

Introduction: Thoracic paravertebral block (PVB) block is frequently used in breast cancer surgery for postoperative pain management. Adding opioids to local anaesthetics has been shown to have beneficial effects during epidural analgesia. Our hypothesis was that adding morphine to bupivacaine for PVB would improve analgesia provided by this procedure. Methods: 60 patients (25 - 75 years) undergoing elective surgery for breast cancer were randomly assigned to one of two groups. Both groups received a single injection thoracic paravertebral block; group BAM with 20 ml 0.5% bupivacaine, epinephrine and morphine while group BA received identical block except morphine was given subcutaneously. All patients had general anaesthesia. Results: Severity of pain and nausea was low in both groups. Pain scores remained below 20/100 after the first 2 hours throughout the 72 hours of the study. There was no significant difference between the groups in pain scores, consumption of additional morphine or nausea scores. Shoulder mobility was also very good in both groups. Conclusion: Thoracic paravertebral block with bupivacaine and epinephrine was associated with good postoperative analgesic effects and low incidence of nausea and vomiting. The addition of morphine to the local anaesthetic solution in paravertebral block did not have any additional analgesic effects.

Keywords

Thoracic Paravertebral Block; Bupivacaine; Epinephrine; Morphine; Breast Cancer

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	F. Pusch, H. Freitag, C. Weinstabl, R. Obwegeser, E. Huber and E. Wildling, “Single-Injection Paravertebral Block Compared to General Anaesthesia in Breast Surgery,” Acta Anaesthesiologica Scandinavia, Vol. 43, No. 7, 1999, pp. 770-774. doi:10.1034/j.1399-6576.1999.430714.x
[2]	M. M. Najarian, J. M. Johnson, J. Landercasper, P. Havlik, P. J. Lambert and D. McCarthy, “Paravertebral Block: An Alternative to General Anesthesia in Breast Cancer Surgery,” American Surgery, Vol. 69, No. 3, 2003, pp. 213-218.
[3]	P. M. Kairaluoma, M. S. Bachmann, A. K. Korpinen, P. H. Rosenberg and P. J. Pere, “Single-Injection Paravertebral Block before General Anesthesia Enhances Analgesia after Breast Cancer Surgery with and without Associated Lymph Node Biopsy,” Anesthesia & Analgesia, Vol. 99, No. 6, 2004, pp. 1837-1843. doi:10.1213/01.ANE.0000136775.15566.87
[4]	J. F. Moller, L. Nikolajsen, S. A. Rodt, H. Ronning and P. S. Carlsson, “Thoracic Paravertebral Block for Breast Cancer Surgery: A Randomized Double-Blind Study,” Anesthesia & Analgesia, Vol. 105, No. 6, 2007, pp. 1848-1851. doi:10.1213/01.ane.0000286135.21333.fd
[5]	G. Hura, P. Knapik, H. Misio?ek, A. Krakus and J. Karpe, “Sensory Blockade after Thoracic Paravertebral Injection of Ropivacaine or Bupivacaine,” European Journal of Anaesthesiology, Vol. 23, No. 8, 2006, pp. 658-664. doi:10.1017/S0265021506000561
[6]	G. Niemi and H. Breivik, “Epidural Fentanyl Markedly Improves Thoracic Epidural Analgesia in a Low-Dose Infusion of Bupivacaine, Adrenaline and Fentanyl. A Randomized, Double-Blind Crossover Study with and without Fentanyl,” Acta Anaesthesiologica Scandinavia, Vol. 45, No. 2, 2001, pp. 221-232. doi:10.1034/j.1399-6576.2001.450214.x
[7]	G. Niemi and H. Breivik, “Adrenaline Markedly Improves Thoracic Epidural Analgesia Produced by a Low-Dose Infusion of Bupivacaine, Fentanyl and Adrenaline after Major Surgery. A Randomised, Double-Blind, Cross-Over Study with and without Adrenaline,” Acta Anaesthesiologica Scandinavia, Vol. 42, No. 8, 1998, pp. 897-909.doi:10.1111/j.1399-6576.1998.tb05348.x
[8]	G. Niemi and H. Breivik, “Epinephrine Markedly Improves Thoracic Epidural Analgesia Produced by a Small-Dose Infusion of Ropivacaine, Fentanyl, and Epinephrine after Major Thoracic or Abdominal Surgery: A Randomized, Double-Blinded Crossover Study with and without Epinephrine,” Anesthesia & Analgesia, Vol. 94, No. 6, 2002, pp. 1598-1605.
[9]	G. Niemi and H. Breivik, “The Minimally Effective Concentration of Adrenaline in a Low-Concentration Thoracic Epidural Analgesic Infusion of Bupivacaine, Fentanyl and Adrenaline after Major Surgery. A Randomized, Double-Blind, Dose-Finding Study,” Acta Anaesthesiologica Scandinavia, Vol. 47, No. 4, 2003, pp. 439-450.doi:10.1034/j.1399-6576.2003.00077.x
[10]	M. J. Eason and R. Wyatt, “Paravertebral Thoracic Block— A Reappraisal,” Anaesthesia, Vol. 34, No. 7, 1979, pp. 638-642. doi:10.1111/j.1365-2044.1979.tb06363.x
[11]	W. D. Dupont and W. D. Plummer Jr., “Power and Sample Size Calculations for Studies Involving Linear Regression,” Controlled Clinical Trials, Vol. 19, No. 6, 1998, pp. 589-601. doi:10.1016/S0197-2456(98)00037-3