Multimodal perioperative analgesia with paravertebral nerve block (PVB) and gabapentin decreases the length of hospitalisation and narcotic usage in patients undergoing mastectomy compared to conventional postoperative management with on-demand postoperative medications (CPM), according to a study presented here at the 37th Annual San Antonio Breast Cancer Symposium (SABCS).
The researchers say that the multimodality approach thereby significantly improves the postoperative management course.
Zandra H. Cheng, MD, Stamford Hospital, Stamford, Connecticut, and coworkers reported the findings.
The researchers reviewed the records of 155 patients undergoing mastectomy at their institution over a recent 5-year period. The patients were grouped by perioperative analgesia type: CPM, PVB by catheter infusion, and PVB with gabapentin (PVB+G).
With each additional analgesia modality, the average length of hospital stay and narcotic usage were reduced compared with CPM. For example, the length of stay was 2.24 days for CPM, 2.10 days for PVB, and 1.60 days for PVB+G. Narcotic usage was 93.7 mg MS04 for CPM, 73.0 mg MS04 for PVB, and 42.9 mg MS04 for PVB+G.
Although the use of PVB decreased the length of stay and narcotic usage compared with CPM, a statistically significant (P ˂ .005) decrease was found only with PVB+G using independent Student’s t test. This significance was found across various types of reconstruction.
The research team was not able to collect data on outpatient narcotic usage, but other studies have demonstrated decreased durations of postoperative pain and narcotic usage with both regional anaesthesia and postoperative gabapentin.
Dr. Cheng noted that the proficiency of the anaesthesiologists in performing PVB may have improved over time, thereby improving pain control. However, the study data demonstrated an increasing trend in bilateral procedures and reconstruction during the same period, which would be expected to result in increases in the average narcotic usage and length of stay. Instead, the study showed a demonstrable decrease in both, thus validating the impact of multimodal analgesia.