Comparison of efficacy of ultrasound-guided single-level thoracic paravertebral block and complete antethoracic block for postoperative analgesia in modified radical mastectomy: A noninferiority randomized controlled trial

Abstract Background and Aims: Thoracic paravertebral block (PVB) is the current gold standard technique for perioperative analgesia in breast surgeries. However, it has been associated with axillary sparing. Hence, we have attempted here to block the nerve supply of the entire chest wall with multiple nerve blocks given as the complete antethoracic block (CAB) and compared its analgesic efficacy with the PVB. Material and Methods: Seventy patients between 18 and 70 years, posted for modified radical mastectomy, were included and analyzed in this study. These patients were randomly allocated to group A or B to receive PVB or CAB, respectively. Thoracic paravertebral block was given to Group A patients with 25 ml of 0.5% ropivacaine. Complete antethoracic block was given with 60 ml of 0.2% ropivacaine. Duration of analgesia, postoperative pain scores, and patient satisfaction scores were noted. The statistical software STATA (version 14) was used for all statistical analyses. Results: The CAB group had a longer duration of analgesia than the PVB group, but noninferiority could not be established because the upper limit of the confidence interval (CI) exceeded both margins. Lower pain scores were recorded in the first 2 hours in the CAB group. There was no significant difference in terms of patient satisfaction between the two groups. Conclusions: CAB is a potential alternative technique for providing analgesia for breast surgeries and can be considered in breast surgeries where PVB is not feasible.