外科ジャーナル

Anything Other than Pain that Matters after Breast Cancer Surgery? A Randomized Controlled Study Comparing Three Anesthetic Modalities

Abstract

Nai-Liang Li, Chii-Ming Chen, Wen-Ling Peng, Skye Hung-Chun Cheng, Chen-Fang Hung and Wen-Hsin Kao

Background: Paravertebral block (PVB) was shown to reduce postoperative pain and postoperative nausea and vomiting for breast surgery. However, there is no evidence showing that these benefits were solely provided by PVB and positively influence patient-perceived outcomes after breast cancer surgery.

Methods: One hundred breast cancer patients were randomized into three groups: general anesthesia (GA, n=34), GA with PVB (GA+ PVB, n=33), PVB with sedation (PVB, n=33). The quality of recovery (QoR) score was assessed preoperatively as baseline, 6 hours postoperatively, and on postoperative day (POD) 1. Analgesia effects, adverse events, and perioperative satisfactions were also assessed.

Results: The rate of QoR 6 hours reaching 18 in GA group (25.53%) seemed to be lower compared with GA+PVB (30.3%) or PVB (42.42%) but without statistical significance. Nevertheless, multivariate logistic regression analysis demonstrated that modality of PVB affected QoR 6 hours (p=0.04). Analgesic consumptions and pain scores were significantly higher and time to first request of analgesics shorter in GA group. The incidences of the GA-related undesired effects were significantly lower and satisfaction with emergence significantly better (P < 0.0001) in PVB group when compared with GA group. There was no difference between GA and GA+PVB in these outcomes.

Conclusions: Anesthesia modalities containing PVB provided better pain control. Anesthesia modalities avoiding GA, i.e. PVB alone, led to significantly lower incidences of GA-related adverse events, significantly better satisfaction with the process of emergence, and contribution to QoR 6hours reaching 18.