Thoracic paravertebral block for breast surgery

Cosmetic and reconstructive breast augmentation is a frequently performed s urgical procedure. Despite advances in medical treatment, surgical interven tion is often associated with postoperative pain, nausea, and vomiting. Par avertebral nerve block (PVB) has the potential to offer long-lasting pain r elief and fewer postoperative side effects when used for breast surgery. We compared thoracic PVB with general anesthesia for cosmetic breast surgery in a single-blinded, prospective, randomized study of 60 women scheduled fo r unilateral or bilateral breast augmentation or reconstruction. Patients w ere assigned (n = 30 per group) to receive a standardized general anestheti c (GA) or thoracic PVB (levels T1-7). Procedural data were collected, as we ll as verbal and visual analog pain and nausea scores. Verbal postoperative pain scores were significantly lower in the PVB group at 30 min (P = 0.000 5), 1 h (P = 0.0001), and 24 h (P = 0.04) when compared with GA. Nausea was less severe in the PVB group at 24 h (P = 0.04), but not at 30 min or 1 h. We conclude that PVB is an alternative technique for cosmetic breast surge ry that may offer superior pain relief and decreased nausea to GA alone.