Pusch et al., 1999; Austria |
86 42 – GA; 44 – TPVB |
Prospective |
GA: 53 years; TPVB: 51 years |
VAS |
Compare TPVB with GA in breast cancer surgery (quadrantectomy, simple mastectomy; mastectomy and axillary dissection) |
(1) TPVB: injection of 5% bupivacaine (0.3 mL kg-1) in the T4 level (maximum dose of 150 mg); (2) GA: IV induction of propofol (2–3 mg kg-1) and fentanyl (2.3 mcg); (3) SPVB |
Vomiting GA: 12 patients; TPVB: 4 patients |
TPVB was a good alternative to breast cancer surgery, with good results |
|
Klein et al., 2000; North Carolina |
59 30 – GA; 29 – TPVB |
Randomized, prospective, and double-blind |
GA: 44 years; TPVB: 48 years |
VAS; NRS |
Compare TPVB with GA in patients undergoing breast reconstruction after breast cancer |
(1) TPVB: injection of 4 mL of 0.5% bupivacaine with 1: 400,000 epinephrine in T1–T7 level; (2) GA: induction with propofol (1.5–2 mg kg-1), fentanyl with isoflurane (1–3 mcg kg-1), and NO in oxygen; (3) MPVB |
Vomiting 30 min – TPVB × GA (p = 0.11); 1 h – TPVB × GA (p = 0.26); 24 h – TPVB × GA (p = 0.04) |
TPVB was a surgical alternative to breast reconstruction, offering less pain and nausea compared to GA alone |
|
Terheggen et al., 2002; Arnhem/Netherlands |
25 10 – TPVB; 15 – GA |
Randomized and prospective |
TPVB: 48 years; GA: 51 years |
VAS |
Evaluate the effectiveness of TPVB with GA in patients undergoing quadrantectomy with or without sentinel lymph node |
(1) TPVB: injection of 5% bupivacaine (15–20 mL) with 1: 200,000 epinephrine, through a catheter inserted at T3–T4 interspace. Catheter was removed after surgery; (2) GA: induction with fentanyl (1–1.5 mcg kg-1) and propofol infusion (3–5 mcg mL-1); with mixture of oxygen and NO (1:2); (3) SPVB |
(1) Dyspnea and hypotension (1 TPVB patient); (2) Accidental pleural puncture (1 TPVB patient); (3) There was no complication in GA group |
TPVB risk–benefit showed no favorable results for this type of surgery |
|
Kairaluoma et al., 2004; Finland |
60 30 – TPVB; 30 – GA
|
Randomized |
TPVB: 52 years; GA: 55 years |
VAS; Motion evaluation (flexion and abduction) |
Assess the possible effects of TPVB with bupivacaine or saline before GA |
(1) TPVB: bupivacaine 5 mg mL-1 in T3 level and lidocaine 2–5 mL; (2) GA: induction with propofol (2–3 mg kg-1). Sevoflurane and 40% oxygen (BIS monitoring). All patients were intubated and ventilated with PPVC; (3) SPVB |
Vomiting GA: 17 patients; TPVB: 10 patients; p = 0.069 |
‘There was significant difference between groups. TPVB allowed greater movement of the shoulder; less pain (p = 0.019). There was rapid recovery of psychomotor function, as well as ocular control in TPVB group |
|
Iohom et al., 2006; Ireland |
29 15 – GA; 10 – TPVB |
Randomized and prospective |
GA: 59 years; TPVB: 65 years |
VAS McGill Pain Questionnaire |
Compare the effects of two analgesic regimens and the probability of chronic pain development after breast surgery; Associate plasma concentrations of NO and the likelihood of subsequent development of chronic pain |
(1) TPVB: 1% lidocaine (2–5 mL) at T3 level; (2) GA: induction with 8% sevoflurane in 100% oxygen; (3) CPVB |
One patient in group CPVB developed Horner's syndrome |
There was no association between NO and the subsequent development of chronic pain after axillary dissection |
|
Kairaluoma et al., 2006; Finland |
60 30 – TPVB; 30 – GA |
Randomized, prospective, and double-blind |
– |
VAS; POMS; NRS |
Determine if TPVB would be associated with less neuropathic pain after surgery for breast cancer (axillary dissection and sentinel node) |
(1) TPVB: 0.5% bupivacaine (1.5 mg kg-1) at T3 level; (2) GA: induction with propofol (2–3 mg kg-1). Sevoflurane and 40% oxygen (BIS monitoring). All patients were intubated and ventilated with PPVC; (3) SPVB |
There were no reports of postoperative complications |
Incidence of stiffness in surgical scar, sensory disorders, musculoskeletal symptoms, restriction of shoulder movement, and edema were not significantly different between groups. No patient reported phantom pain |
|
Burlacu et al., 2006; Ireland |
52 (1) 13–19 mL of levobupivacaine – TPVB; (2) 19 mL of levobupivacaine and 0.25% fentanyl – TPVB; (3) 19 mL of levobupivacaine and 0.25% clonidine – TPVB; (4) Control group – GA |
Group 1: 51 years; Group 2: 54 years; Group 3: 53 years; Group 4: 57 years |
Randomized |
VAS; OAA/S |
Compare the different postoperative effects between GA and TPVB |
(1) Group 1: 19 mL bolus levobupivacaine 0.25% plus 1 mL saline followed by an infusion of levobupivacaine 0.1%; (2) Group 2: 19 mL bolus levobupivacaine 0.25% plus fentanyl 50 mg mg (1 mL de volume) followed by infusion of levobupivacaine 0.05% with fentanyl 1 g mL-1 (3) Group 3: 19 mL bolus levobupivacaine 0.25% plus clonidine 150 mg (1 mL volume) before surgical incision, followed by an infusion of levobupivacaine 0.05% with clonidine (3 mg mL-1) at T3 level; (4) GA: induction with propofol (2–3 mg kg-1); (5) CPVB |
Nausea (p = 0.04) |
TPVB significantly decreased postoperative pain (quadrantectomy, mastectomy, and mastectomy followed by immediate reconstruction) |
|
Moller et al., 2007; Denmark |
79 38 – TPVB; 41 – GA |
TPVB: 57.6 years; Placebo: 57.2 years |
Randomized, double-blind |
NRS; PONV |
Examine whether TPVB along with propofol and laryngeal mask performed before GA improves postoperative analgesia in mastectomy with SNB or tumor resection |
(1) TPVB: 0.5% ropivacaine (30 mL); lidocaine (5 mL) in transverse process at C7–T5 level; (2) GA: propofol (2–3 mg kg-1) and fentanil; (3) MPVB |
(1) Nausea – TPVB and GA (7)/placebo (9); (2) Vomiting – TPVB and GA (2)/placebo (1); (3) Sleep disorders – TPVB and GA (8)/placebo (7) |
Fentanyl consumption was significantly lower in TPVB group during anesthesia. Pain severity was lower in TPVB group with p < 0.0001 |
|
Dabbagh, Elyasi; 2007; Iran |
60 30 – TPVB; 30 – GA |
– |
Randomized |
NRS |
Compare whether TPVB intervenes positively in pain scores, morphine consumption as rescue analgesia, and length of hospital stay after simple mastectomy |
(1) TPVB: injection of 2% lidocaine (15 mL) at T4 level; (2) GA: thiopental with halothane (4–5 mg kg-1) in a mixture of 1:1 NO and oxygen; (3) SPVB |
There were no reports of postoperative complications |
TPVB produced fewer complications, decreased pain intensity, can be an alternative method for breast surgery |
|
Sidiripoulou et al., 2007; Italy |
48 24 – TPVB; 24 – GA |
TPVB: 64 years; GA: 67 years |
Randomized |
VAS; Motion evaluation (shoulder abduction and external/internal rotation) |
Compare GA and TPVB regarding analgesic efficacy and morphine consumption after mastectomy |
(1) TPVB: 2% lidocaine (5 mL) at T1–T5 levels; (2) GA: induction of propofol and sufentanil (0.3–0.5 mcg kg-1); (3) SPVB |
Nausea and vomiting (1) TPVB and GA: 5 patients; (2) Placebo: 15 patients |
Vomiting was more frequent in GA group. Morphine consumption did not differ between the two groups. Incidence of nausea and vomiting was lower in TPVB group |
|
McElwain et al., 2008; Ireland |
37 (1) 15 min: 19; (2) 30 min: 18 |
(1) 15 min: 55 years; (2) 30 min: 54 years |
Prospective, randomized, double-blind |
VAS |
Compare pain scores between TPVB and GA |
(1) 15 min – levobupivacaine – 0.2% (bolus: 3 mL); (2) 30 min – levobupivacaine – 0.2% (bolus: 8 mL); (3) GA: induction of 0.25% levobupivacaine 20 mL bolus (paracetamol 1 g; diclofenac 75 mg;, ondansetron 4m;, morphine 0.15 mg kg-1) |
Horner's syndrome, asymptomatic bradycardia, infection, catheter disconnection |
There were no significant differences in pain intensity and arm movements. There were fewer side effects and greater patient satisfaction with TPVB |
|
Boughey et al., 2009; United States |
80 41 – GA; 39 – TPVB with GA |
GA: 57.9 years; TPVB: 53 years |
Prospective and randomized |
NRS |
Evaluate the effect of GA using TPVB. The objective is pain control after mastectomy without plastic reconstruction |
(1) TPVB: 1% and 5% ropivacaine with 1:400,000 epinephrine at T1–T6 level; (2) GA: monitored cardiovascular parameters; 3–6 mL of 5% ropivacaine with 1:4,000,000 epinephrine; prophylaxis for nausea and vomiting (dexamethasone, ondansetron, and promethazine) (3) MPVB |
There was no difference between groups in scores for nausea and vomiting and other complications |
TPVB significantly decreased postoperative pain |
|
Buckenmaier et al., 2010; Pennsylvania |
73 (1) 23 – Placebo; (2) 27 – CPVB + GA; (3) 26 – CPVB + GA |
(1) Placebo: 58.4 years; (2) 54.3 years; (3) 54.8 years
|
Prospective, randomized, double-blind, and placebo-controlled |
Likert scale; Wong-Baker Faces Pain Rating Scale; McGill Pain Questionnaire; Profile of Mood States; Mc Cockle Symptom Distress Scale |
Compare pain, nausea, and mood between TPVB and GA groups |
(1) TPVB: 5 mL ropivacaine and 1:400,000 epinephrine at T1–T6 level; (2) GA: lidocaine 1% com epinefrina 1:200,000 (3) CBPV |
Seroma (2); Lymphedema (2); Surgical site infection (1); Horner's syndrome (1) |
TPVB use was not sustained with significance in this study |
|
Ibarra et al., 2011; Spain |
29 14 – GA 15 – GA +TPVB |
– |
Randomized |
VAS; Neurostimulation for TPVB; telephone Interview |
Determine the association between anesthetic technique, intensity of postoperative pain, and chronic pain development |
(1) Balanced anesthesia with sevoflurane, remifentanil; (2) Balanced anesthesia with sevoflurane, remifentanil combined with TPVB |
Group 1: (1) Neuropathic pain: 43%; (2) Phantom breast: 21%; (3) Myofascial pain: 33%; SDPM: 50% Group 2: Neuropathic pain: 6.7%; Phantom breast: 0%; Myofascial pain: 43%; SDPM: 6.7% |
Neuropathic pain was more frequent in GA patients, with a greater tendency to develop phantom breast sensation |
|
Bhuvaneswari et al., 2012; India |
48 (G1) 12; (G2) 12; (G3) 12; (G4) 12 |
G1: 50.7 years; G2: 49.1 years; G3: 48.7 years; G4: 49 years |
Randomized |
VRS; NRS; PONV |
Evaluate the effectiveness of lower concentrations of bupivacaine with or without fentanyl in PVB in patients undergoing breast cancer surgery |
(G1): 0.25% bupivacaine + bupivacaine 5 mg mL-1; (G2) 0.25% bupivacaine + bupivacaine 5 mg mL-1 + fentanil – 2 mg mL-1; (G3) 0.5% bupivacaine + bupivacaine 5 mg mL-1; (G4) Saline |
There were no complications |
Results show that analgesic consumption, pain assessment, and duration of analgesia were comparable among patients receiving TPVB with 0.5% bupivacaine and 0.25% bupivacaine + fentanyl. 0.25% bupivacaine + epinephrine combined with fentanyl (2 µg mL-1) provides excellent postoperative analgesia comparable to 0.5% bupivacaine + epinephrine, with the advantage of a lower toxicity profile when used for a single level of TPVB for breast surgery |