Anesthesiologists searching for a simple alternative to the paravertebral block in breast surgery patients might consider a technique adopted by researchers at the University of Ottawa, in Ontario. Their two-step surgical field block proved comparable to the paravertebral block in all measured outcomes in the early postoperative period and in the setting of chronic postsurgical pain.
Patients in the paravertebral block group had a T1-T6 paravertebral block with 5 mL of 0.5% ropivacaine per level; saline was injected by the surgeon into the wound and into the drain. Those in the surgical field block group received subcutaneous saline injections at T1-T6, with 10 mL of 0.5% ropivacaine injected by the surgeon into the wound and 20 mL into the surgical drain.
“We then analyzed these data looking at the quality of recovery score, predominantly on day 2, because we felt that this was a good reflection of the patients’ postoperative function,” Dr. Ben-Zeev explained. “We also looked at the proportion of patients with pain greater than 3 [on the Numeric Rating Scale (NRS)] on postoperative day 2. And the third thing we looked at was the shoulder and arm disability, by measuring something called the Constant score, which is a validated 100-point metric used by orthopedic surgeons looking at things like activities of daily living, pain, range of motion and power.”
Furthermore, the differences in quality of recovery and NRS pain scores were not significant in repeated measures analysis (P=0.76 and P=0.25, respectively).