Background and Goal of Study: Both paravertebral block (PVB) and thoracic epidural block
(TEB) are established techniques for postoperative
pain relief in thoracic and breast surgeries.
Breast surgeries are associated with postoperative
pain, nausea and vomiting. With medical
advances and rise in ambulatory surgeries there is a growing interest towards regional anaesthesia
for breast surgeries. Our study compares two known regional techniques with sedation as the sole
anaesthetic plan for benign breast surgeries in terms of intraoperative haemodynamics, postoperative
pain, side effects and patient satisfaction.
Materials and methods: After ethical committee approval, 80 patients scheduled for unilateral
simple mastectomy were randomized to receive either TEB or PVB. The anaesthetic and analgesic
protocols were similar in both groups. Patients in each group received 15 ml of 0.5% Bupivacaine
either in the thoracic paravertebral region or thoracic epidural region. The primary endpoint
consisted to measure the frequency of hypotension episodes defined by a mean arterial pressure
(MAP) less than 60 mmHg or a decrease in MAP greater than 20% when compared with the
preoperative value. Secondary endpoints evaluated the amount of intraoperative fluid administration,
the use of vasopressor drugs, the analgesic efficacy assessed by the visual analogue scale (VAS),
any postoperative events such as PONV, shivering or respiratory complications.
Results and discussion: As compared to the PVB group the TEB group showed significant
decrease in both mean blood pressure and heart rate during most of the intraoperative period. The
intraoperative fluid consumption was higher in the TEB group as compared to the PVB group. In
Group TEB 25% (10/40) patients required vasopressors as compared to 10% (4/40) in Group PVB.
The total rescue analgesic consumption between the two groups were comparable. Postoperative
VAS between the studied groups was similar. Postoperative events in both the groups were
comparable.
Conclusion(s): Single injection PVB and TEB had similar quality of surgical anaesthesia, postoperative
pain relief and patient satisfaction however PVB had better hemodynamic stability than
TEB in patients undergoing breast surgeries. Further data and studies will be required to confirm this
preliminary study.

Comparison between single dose paravertebral block and thoracic epidural block for breast surgeries: a prospective randomized study