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Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study

  • Breast Oncology
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Abstract

Background

In a previous randomized, triple-masked, placebo-controlled study, the authors demonstrated that extending a single-injection paravertebral nerve block with a multiple-day perineural local anesthetic infusion improves analgesia and decreases pain-related dysfunction during the 3-day infusion but not subsequent to catheter removal within 1 month after mastectomy. This report describes a prospective follow-up study of the previously published trial to investigate the possibility that extending a single-injection paravertebral block with a multiple-day infusion may decrease persistent postsurgical pain as well as pain-induced emotional and functional dysfunction 1 year after mastectomy.

Methods

Subjects undergoing uni- or bilateral mastectomy received unilateral (n = 24) or bilateral (n = 36) single-injection thoracic paravertebral block(s) with ropivacaine and perineural catheter(s). The subjects were randomized to receive either ropivacaine 0.4 % (n = 30) or normal saline (n = 30) via their catheters until the catheters were removed on postoperative day 3. Chronic pain and pain-related physical and emotional dysfunction were measured using the Brief Pain Inventory (BPI).

Results

No statistically significant difference between treatments 3 months after surgery was observed with the BPI. In contrast, after 12 months, only 4 subjects (13 %) who had received a perineural ropivacaine infusion reported pain-induced dysfunction compared with 14 (47 %) who had received saline infusion (P = 0.011). At 12 months, the mean BPI was 1.6 ± 4.6 for the subjects who received ropivacaine versus 5.9 ± 11.3 for the subjects who received saline (P = 0.007).

Conclusions

Adding a multiple-day, continuous ropivacaine infusion to a single-injection ropivacaine paravertebral nerve block may result in a lower incidence of pain as well as pain-related physical and emotional dysfunction 1 year after mastectomy.

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Acknowledgment

Funding for this project was provided by National Institutes of Health Grant GM077026 (P.I.: Dr. Ilfeld) from the National Institute of General Medical Sciences (Bethesda, MD, USA); the Clinical and Translational Research Institute, University of California, San Diego (San Diego, CA, USA), with funding provided by National Institutes of Health grants UL1RR031980 and UL1TR000100; the Department of Anesthesiology, University of California San Diego (San Diego, CA, USA) and Baxter Healthcare International (Deerfield, IL, USA). This company also provided the portable infusion pumps used in the original investigation but had no input into any aspect of study conceptualization, design and implementation, data collection, analysis and interpretation, or manuscript preparation. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding entities.

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There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Anesthesiology, University of California San Diego, San Diego, CA, USA

    Brian M. Ilfeld MD, MS, Sarah J. Madison MD, Preetham J. Suresh MD, NavParkash S. Sandhu MD, MS, Nicholas J. Kormylo MD, Nisha Malhotra MD, Vanessa J. Loland MD, Mark S. Wallace MD & Anya C. Morgan MA, CCRC

  2. Department of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA

    Edward J. Mascha PhD & Zekun Xu MS

  3. Department of Ophthalmology, University of California San Diego, San Diego, CA, USA

    Cindy H. Wen BS

  4. Department of Surgery, University of California San Diego, San Diego, CA, USA

    Anne M. Wallace MD

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  1. Brian M. Ilfeld MD, MS
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  2. Sarah J. Madison MD
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Correspondence to Brian M. Ilfeld MD, MS.

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Ilfeld, B.M., Madison, S.J., Suresh, P.J. et al. Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study. Ann Surg Oncol 22, 2017–2025 (2015). https://doi.org/10.1245/s10434-014-4248-7

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