Comparison between thoracic paravertebral block and segmental thoracic spinal anesthesia in breast cancer surgery

Abstract

Background: Thoracic paravertebral block (TPVB) and segmental thoracic spinal anesthesia (STSA) can be used as sole anesthesia techniques alternative to general anesthesia for modified radical mastectomy in some critical patients. Both techniques were compared for efficacy and safety including detailed block characteristics, analgesia, patient's and surgeon's satisfaction, hemodynamics, respiration, and side effects. Results: Both techniques were successful, but fentanyl requirements were higher in TPVB group. The sensory loss was faster, wider, and longer in STSA group; however, it was associated with more hypotension. There was no motor block in the upper or lower limbs in TPVB group, while all patients in STSA group showed ipsilateral handgrip affection and to less extent wrists and then elbow flexion. While the ipsilateral lower limbs motor block was partial and short. Postoperatively, there was no difference in analgesic requirements or side effects. Satisfaction was higher in STSA group. Conclusions: Both TPVB and STSA were effective and safe as sole techniques for mastectomy providing adequate anesthesia with low complications, considerable analgesia, and satisfaction. Anesthesia was faster, wider, and longer in STSA group, with lower fentanyl requirements; however, it was associated with more hypotension.