The Impact of Paravertebral Block Analgesia on Breast Cancer Survival After Surgery

• Published in: Regional anesthesia and pain medicine Vol. 41; no. 6; pp. 696 - 703
• Main Authors: Cata, Juan P, Chavez-MacGregor, Mariana, Valero, Vicente, Black, Walter, Black, Daliah M, Goravanchi, Farzin, Ifeanyi, Ifey C, Hernandez, Mike, Rodriguez-Restrepo, Andrea, Gottumukkala, Vijaya
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2016
• Subjects: Adult; Analgesia - adverse effects; Analgesia - methods; Analgesia - mortality; Analgesics; Analgesics, Opioid - therapeutic use; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - surgery; Disease-Free Survival; Female; Fentanyl - therapeutic use; Humans; Hypotheses; Kaplan-Meier Estimate; Local anesthesia; Mastectomy - adverse effects; Mastectomy - mortality; Middle Aged; Nerve Block - adverse effects; Nerve Block - methods; Nerve Block - mortality; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - mortality; Pain, Postoperative - prevention & control; Postoperative period; Propensity Score; Proportional Hazards Models; Regional anesthesia; Retrospective Studies; Risk Factors; Surgery; Time Factors; Treatment Outcome
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1097/AAP.0000000000000479

The impact of regional anesthesia on breast cancer recurrence is controversial. We tested the hypothesis that the use of paravertebral block (PVB) analgesia during breast cancer surgery prolongs the recurrence-free survival (RFS) and overall survival (OS) of women with breast cancer. Seven hundred ninety-two women with nonmetastatic breast cancer were included in this retrospective study. Patients were divided based on the administration of PVB analgesia for mastectomy surgeries. One hundred ninety-eight (25%) were given a PVB, the remainder were treated with opioid-based analgesia. Propensity score matching was developed using several variables. Univariate and multivariate analyses were used to assess the impact of PVB analgesia on RFS and OS. The median follow-up times for RFS and OS were 5.8 and 6 years, respectively. In the propensity score matching model, a total of 396 women were included in each group of treatment (non-PVB group, n = 198 vs PVB group, n = 198). As expected, the fentanyl consumption was significantly lower in PVB (122.8 ± 77.85 μg) patients than non-PVB subjects (402.23 ± 343.8 μg). Other variables were not statistically significant. After adjusting for several important covariates, the analysis indicated that the use of PVB is not associated with a significant change in RFS [1.60 (0.81-3.16), P = 0.172] or OS [1.28 (0.55-3.01)] survival. This retrospective study does not support the hypothesis that the use of regional analgesia is associated with longer survival after surgery for breast cancer.