Table 3.
Nerve Block Studies
| Reference | Procedure | Intervention | Follow-up (mo), Avg (Range) | Outcome measures | Findings |
|---|---|---|---|---|---|
| Besch et al., 201019 | Breast cancer surgery | Perioperative GA with pectoral nerve block | 6 | Presence of pain (Breast Cancer Pain Questionnaire), Pain intensity | Pectoral block had no effect on incidence nor severity of persistent post-surgical pain |
| De Cassai et al., 201918 | Mastectomy or lateral quadrantectomy | PECS II block | 12 | Presence of pain, intensity of pain (NRS) | PECS II decreased incidence of chronic pain only for 3 months compared to GA alone (P = 0.039). It did not decrease pain intensity. |
| Fujii et al., 201820 | Mastectomy | PECS II block | 6 | Presence of pain, pain intensity (NRS), health-related QOL (EQ-5D-3L questionnaire) | PECS II reduced incidence of moderate and severe chronic pain compared to serratus plane block (P = 0.02). |
| Strazisar et al., 201415 | Breast cancer surgery with ALND | Wound catheter with continuous infusion of local anesthetic | 6 | Presence of pain | Infusion of local anesthetic did not significantly decrease incidence of neuropathic pain compared to standard IV analgesia (20% vs. 40%, P = 0.09) |
| Mohamed et al., 201817 | Modified radical mastectomy with ALND | Wound irrigation with bupivacaine plus 5, 10 or 15 mg morphine | 3 | Location, intensity, nature and duration of pain, analgesic medication use, LANSS Pain Scale | The lowest mean LANSS score was recorded in the Morphine 15 group compared with Morphine 5 and Morphine 10 (P < 0.006). |
| Albi-Feldzer et al., 200016 | Breast cancer surgery | Wound infiltration with repeated injections of local anesthetic | 12 | Presence of pain, pain intensity at rest and movement, pain interference (BPI), neuropathic pain (DN4) | Ropivacaine wound infiltration did not decrease chronic pain intensity or incidence. |
| Gacio et al., 201821 | Major resection for breast cancer | Single TPVB injection | 6 | ||
| Pain intensity at rest and with movement in ipsilateral arm (VAS), neuropathic pain (DN3), QOL (EORTC QLQ-C30) | Single-injection PVB had no effect on intercostobrachial neuralgia (P = 0.3). | ||||
| Kairaluoma et al., 200626 | Conservative breast surgery for cancer with SENTINEL lymph node biopsy | Single TPVB injection | 12 | Presence of pain, pain intensity at movement and rest (NRS), pain characteristics | PVB lowered pain incidence (P = 0.003), intensity at rest (P = 0.011) and movement (P = 0.003). |
| Shimizu et al., 201523 | Breast cancer surgery | Ultrasound-guided single TPVB injection | 15 (13, 17) | Pain intensity (VRS) | TPVB significantly lowered incidence of chronic pain (P = 0.039). |
| Karmakar et al., 201724 | Modified radical mastectomy with ALND | Single injection or continuous infusion with catheter of TPVB | 6 | Incidence of pain, pain severity (VRS) at rest and during movement, health-related QOL, Chronic Pain Symptom and Sign Score | No difference in incidence of chronic pain between groups (P = 0.79). Patients receiving TPVB had lower chronic pain scores (P < 0.05) and had fewer symptoms of chronic pain (P ≤ 0.01). |
| Elkaradawy et al., 201228 | Conservative breast surgery for cancer | Ultrasound-guided TPVB with GA | 9 | Neuropathic pain (NPS), Pain intensity (NRS) | TPVB decreased pain intensity (P ≤ 0.05). |
| Ilfeld et al., 201827 | Uni- or bilateral mastectomy | Ultrasound- guided continuous PVB catheter | 12 | Presence of pain, pain intensity and interference (BPI) | PVB catheter significantly decreased incidence (P = 0.011) and intensity of pain (P = 0.007). |
| Qian et al., 201922 | Unilateral partial mastectomy | Ultrasound-guided single-injection multilevel TPVB | 6 | Presence of pain, pain intensity and interference (BPI) | PVB significantly reduced severity (P < 0.001). and incidence (P = 0.03) of chronic pain. |
| Kamal et al., 201925 | Modified radical mastectomy and ALND | Ultrasound-guided multilevel TPVB with 0.5 mg/kg or 1 mg/kg ketamine | 3 | DN4 questionnaire for chronic neuropathic pain | No difference in mean DN4 scores between control, 0.5 mg/kg and 1 mg/kg ketamine (P = 0.132) |
NRS – Numerical rating scale
QOL – Quality of life
LANSS- Leeds Assessment of Neuropathic Symptoms and Signs
BPI – Brief Pain Inventory
DN4 – Douleur neuropathique 4
TPVB – Thoracic paravertebral block
VAS – Visual analogue scale
DN3 – Douleur neuropathique 3
VRS – Verbal rating scale