Guided Paravertebral Blocks With Versus Without Clonidine for Women Undergoing Breast Surgery: A Prospective Double-Blinded Randomized Study

• Published in: Anesthesia and analgesia Vol. 117; no. 1; pp. 252 - 258
• Main Authors: Naja, Zoher M, Ziade, Fouad M, El-Rajab, Mariam A, Naccash, Nicole, Ayoubi, Jean-Marc
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.07.2013
• Subjects: Breast Neoplasms - diagnosis; Breast Neoplasms - surgery; Clonidine - administration & dosage; Double-Blind Method; Female; Humans; Mastectomy - adverse effects; Middle Aged; Monitoring, Intraoperative - methods; Monitoring, Intraoperative - standards; Nerve Block - methods; Nerve Block - standards; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Prospective Studies
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0b013e31828f28d6

BACKGROUND:Paravertebral blocks (PVBs) have been introduced as an alternative to general anesthesia for breast cancer surgeries. The addition of clonidine as an adjuvant in PVBs may enhance quality and duration of analgesia and significantly reduce the consumption of analgesics after breast surgery. In this prospective randomized double-blind study, we assessed the significance of adding clonidine to the anesthetic mixture for women undergoing mastectomy. METHODS:Sixty patients were randomized equally into 2 groups, both of which received PVB block, either with or without clonidine. Analgesic consumption was noted up to 2 weeks after the operation. A visual analog scale was used to assess pain postoperatively during the hospital stay, and a numeric rating scale was used when patients were discharged. RESULTS:Analgesic consumption was significantly lower in the clonidine group 48 hours postoperatively with 95% confidence interval (CI) for the difference (−69.5% to −6.6%). Pain scores at rest showed significant reduction in the clonidine group during the period from 24 to 72 hours postoperatively with 95% CI for the ratios of 2 means (1.09–3.61), (2.04–9.04), and (2.54–16.55), respectively, with shoulder movement at 24, 48, and 72 hours postoperatively 95% CI for the ratio of 2 means (1.10–3.15), (1.32–6.38), and (1.33–8.42), respectively. The time needed to resume daily activity was shorter in the clonidine group compared with the control group with 95% CI for the ratio of 2 means (1.14–1.62). CONCLUSION:The addition of clonidine enhanced the analgesic efficacy of PVB up to 3 days postoperatively for patients undergoing breast surgery.