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: | Jonathan T. Unkart, Mark S. Wallace, NavParkash S. Sandhu, Daphna M. Finn, Nisha Malhotra, Anne M. Wallace, Cindy Wen, Anya C. Morgan, Nicholas J. Kormylo, Preetham Suresh, Vanessa J. Loland, Brian M. Ilfeld, Sarah J. Madison |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Breast Neoplasms Pilot Projects Article law.invention 03 medical and health sciences 0302 clinical medicine Breast cancer Randomized controlled trial Double-Blind Method 030202 anesthesiology law medicine Humans Paravertebral Block Ropivacaine Postoperative Period Prospective Studies Anesthetics Local Mastectomy Pain Postoperative business.industry Retrospective cohort study Nerve Block Perioperative Middle Aged medicine.disease Amides Surgery Catheter Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Anesthesia Female business medicine.drug Follow-Up Studies |
| Zdroj: | Journal of anesthesia. 31(3) |
| ISSN: | 1438-8359 |
| Popis: | 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. 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. 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. 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: | OpenAIRE |
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