PARAVERTEBRAL BLOCK FOR BREAST-CANCER SURGERY

Purpose: Major breast cancer surgery is associated with a high inciden ce of postoperative nausea vomiting and pain. Regional anaesthesia, wi th intraoperative sedation, would seem an ideal alternative to general anaesthesia for this type of surgery. We report our initial experienc e using paravertebral blocks (PVB) to provide anaesthesia for major br east surgery. Methods: Twenty-five patients agreeing to have surgery p erformed under paravertebral blocks were studied. Procedures performed varied from simple lumpectomy with axillary dissection to modified ra dical mastectomy with axillary dissection. During monitored sedation, blocks opposite spinous processes of C-7-T-6 were performed using bupi vacaine 0.5% with epinephrine, 3-4 ml per segment. Patients were evalu ated for 72 hr and were requested to document: (i) when sensation retu rned (ii) incidence and frequency of nausea or vomiting (iii) degree o f 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-opera tively patients with successful blocks had minimal nausea vomiting and pain. No patients found the procedure unsatisfactory. Patients with s uccessful blocks were all very satisfied. Conclusion: Our initial resu lts show that PVB for breast cancer surgery can be successfully perfor med 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 anaesthe sia can be safely performed as an ambulatory procedure has the potenti al for accomplishing major cost-saving.