Paravertebral block for breast cancer surgery

Purpose: Major breast cancer surgery is associated with a high incidence of postoperative nausea vomiting and pain. Regional anaesthesia, with intraoperative sedation, would seem an ideal alternative to general anaesthesia for this type of surgery. We report our initial experience using paravertebral blocks (PVB) to provide anaesthesia for major breast surgery. Methods: Twenty-five patients agreeing to have surgery performed under paravertebral blocks were studied. Procedures performed varied from simple lumpectomy with axillary dissection to modified radical mastectomy with axillary dissection. During monitored sedation, blocks opposite spinous processes of C-7-T-6 were performed using bupivacaine 0.5% with epinephrine, 3-4 ml per segment. Patients were evaluated for 72 hr and were requested to document: (i) when sensation returned (ii) incidence and frequency of nausea or vomiting (iii) degree of discomfort and medication taken. Results: Twenty patients had blocks that required no supplementation. Five patients had blocks that were incomplete. No complications were attributed to the blocks. Post-operatively patients with successful blocks had minimal nausea vomiting and pain. No patients found the procedure unsatisfactory. Patients with successful blocks were all very satisfied. Conclusion: Our initial results show that PVB for breast cancer surgery can be successfully performed in a majority of patients with few side effects. All patients with successful blacks were returned to the ambulatory care unit bypassing the recovery room. That breast cancer surgery under regional anaesthesia can be safely performed as an ambulatory procedure has the potential for accomplishing major cost-saving.