Kolawole IK (2006) [27]

1. 55 years old patient with recurrent left breast tumour with lung metastasis complicated by pleural effusion and pneumonia

2. 60 years old left breast mass with widespread lung metastasis

Palliative simple mastectomy

Intercostal nerves block at thoracic levels 2 - 7; infraclavicular approach to superficial cervical plexus; subcutaneous infiltration in midline to block contralateral intercostal fibres

1) pain-free for 5 hours

2) Uneventful postoperative course


Kairaluoma PM (2004) [28]

60 breast cancer patients

Breast resection or mastectomy with and without associated axillary dissection

GA and PVB with bupivacaine or saline

Significantly less post-operative opioid medication, less pain after 24 h, less PONV in the bupivacaine group

One patient had bilateral convulsions right after bupivacaine injection

Stamatiou G (2004) [29]

24 years old, 14 weeks of gestation, with left breast tumour

Wide local excision of tumour and lymph node dissection

T1-T7 thoracic paravertebral block and superficial cervical nerve block

Tolerated 65 min of operation under sedation with propofol infusion

Total analgesic requirement was 12 mg morphine and 5 g paracetamol for the first 48 hs


Buckenmaier CC 3rd (2002) [30]

72 year old patient with HOCM, emphysema on home oxygen therapy

Left partial mastectomy with axillary dissection for infiltrating ductal carcinoma

Left paravertebral nerve blocks at thoracic levels 1 - 6; left superficial cervical plexus block

Pain free and opioid free on day of operation

4 mg of IV morphine on POD1

Discharged pain free subsequently

Hypotension, attribulated to sedation and possibly hypovolemia from fasting; resolved after fluid challenge

D'Ercole FJ (1999) [31]

38 year old, 29 weeks of gestation with a 10 cm left breast mass

Left modified radical mastectomy with axillary dissection

Left paravertebral nerve blocks at T1-T6

Tolerated procedure

Oral non-opioid analgesia 18 h after neural blockade

Discharged on POD2


Atanassoff PG (1994) [32]

RCT involving 48 ASA I and II patients


3 groups of patients receiving intercostal nerve blockade of T3-6 unilaterally with either 1.5% or 2% lidocaine or 0.5% bupivacaine. 4th group was control who received GA

Significantly higher postoperative pain scores in control group. Number of women requiring post-operative analgesia, total amount of analgesics given during 24 hs post operatively were significantly lower in RA group