The paravertebral lamina technique: a new regional anesthesia approach for breast surgery

Study ObjectiveTo test the feasibility and efficacy of a new approach to paravertebral catheter placement in patients undergoing major surgery of the breast.DesignSingle-group, single-center observational study.SettingOperating room, postoperative recovery area, and normal ward of a university hospital.Patients25 ASA physical status 1, 2, 3, and 4 patients undergoing major unilateral surgery of the breast.InterventionsParavertebral catheters for intraoperative and postoperative anesthesia and analgesia were applied using the recently described lamina technique. This technique is performed at a more medial puncture site, avoiding the pleura.MeasurementsAdditional opioid requirements were recorded to assess effectiveness of regional anesthesia. At the time of catheter withdrawal, patients, staff nurses, and anesthesiologists who provided postoperative pain management were asked to rate their satisfaction with paravertebral catheter effectiveness.Main ResultsAll patients successfully received a paravertebral catheter using the lamina technique. During the surgical procedure, 84% of patients received no additional opioids after intubation. No patient required opioids as rescue medication postoperatively (visual analog scale rating > 30mm) or during the rest of the hospital stay. Postoperative analgesia provided with paravertebral catheters was rated very high by patients, staff nurses, and anesthesiologists involved in postoperative care.ConclusionsThe lamina technique for placement of a paravertebral catheter is a feasible and effective technique for intraoperative and postoperative analgesia in patients scheduled for major breast surgery with or without axillary lymph node resection.