Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation.

Autor:	Finn DM; Department of Psychiatry, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Ilfeld BM; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA. bilfeld@ucsd.edu.; Department of Anesthesiology, Outcomes Research Consortium, Cleveland, OH, USA. bilfeld@ucsd.edu., Unkart JT; Department of Surgery, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Madison SJ; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Suresh PJ; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Sandhu NPS; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Kormylo NJ; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Malhotra N; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.; Department of Anesthesiology, Lawrence and Memorial Hospital, New London, CT, USA., Loland VJ; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.; Department of Anesthesiology, University of Washington, Seattle, WA, USA., Wallace MS; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Wen CH; Department of Ophthalmology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Morgan AC; Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA., Wallace AM; Department of Surgery, University of California San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA.
Jazyk:	angličtina
Zdroj:	Journal of anesthesia [J Anesth] 2017 Jun; Vol. 31 (3), pp. 374-379. Date of Electronic Publication: 2017 Mar 31.
DOI:	10.1007/s00540-017-2345-z
Abstrakt:	Purpose: Retrospective studies have associated perioperative regional anesthesia/analgesia during mastectomy for breast cancer with a decreased incidence of cancer recurrence. However, to date, no prospective data from a randomized controlled trial have been reported. In a previous study we found that extending a single-injection paravertebral block with a multiple-day perineural local anesthetic infusion improves analgesia. This follow-up study investigates the rates of cancer recurrence for the single-injection and multiple-day infusion treatments. Methods: Patients undergoing unilateral (n = 24) or bilateral mastectomy (n = 36) were included in the study. All patients had been diagnosed with breast cancer or tumor in situ, except for six patients who were receiving prophylactic bilateral mastectomy and were excluded from analyses. Patients received unilateral or bilateral single-injection thoracic paravertebral block(s) corresponding to their surgical site(s) with ropivacaine and perineural catheter(s). Subsequently, patients were randomized to receive either ropivacaine 0.4% (n = 30) or normal saline (n = 30) via their catheter(s) until catheter removal on postoperative day 3. Cancer recurrence from the date of surgery until at least 2 years post surgery was investigated via chart review. Results: Five of the 54 (9.2%) patients experienced a cancer recurrence following mastectomy-3 of 26 (11.5%) of the patients with perineural ropivacaine and 2 of 28 (7.1%) of the patients with perineural saline. Conclusions: This pilot study found no evidence that extending a single-injection paravertebral block with a multi-day perineural local anesthetic infusion decreases the risk of post-mastectomy cancer recurrence. However, due to the small sample size of this investigation, further research is needed to draw definitive conclusions.
Databáze:	MEDLINE
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