Reducing Pain and Disability After Breast Cancer Surgery

Efficacy of Thoracic Paravertebral Block in Reducing Chronic Pain and Disability After Breast Cancer Surgery With Axillary Lymph Node Dissection

The purpose of this study is to determine if the combination of thoracic paravertebral block and multimodal analgesia will decrease chronic pain and arm morbidity in patients undergoing breast cancer surgery with lymph node dissection as compared to patients receiving local anesthesia with multimodal analgesia.

Sixty percent of breast cancer patients undergo some form of breast surgery in the treatment of the early stages of the disease. The recovery from surgery can be associated with severe disabling pain persisting beyond 12 months after surgery. Research in pain has shown that early intervention of acute pain can prevent long term chronic pain.

At The Ottawa Hospital, patients receive either paravertebral blocks or wound infiltration with local anesthetic for postoperative pain management. We would like to compare these two methods of pain control to determine an analgesic technique that will reduce acute and chronic pain, and maximally improve long-term functional recovery and patient's quality of life.

Inclusion Criteria:

• Patients with diagnosis of breast cancer
• Scheduled for elective modified radical mastectomy, simple mastectomy with SLNB, breast conserving surgery (ie lumpectomy, segmental mastectomy) with ALND or ALND alone (after positive SLNB)

Exclusion Criteria:

• American Society of Anesthesiologist (ASA) class 4 or 5
• Patients with contraindications to TPVB
• Allergy to study medications
• Chronic opioid use defined as daily consumption of greater than 20 mg of oral morphine or equivalent for >7days
• Renal insufficiency defined as a creatinine clearance <40ml/min as calculated using the Cockroft-Gault formula
• Preoperative radiation therapy
• Inability to achieve normal shoulder range of motion as defined as <100o of shoulder abduction or flexion