paravertebral block?

Skippyrcis - what is a paravertebral block? I had my mastectomy last July & a half hour before surgery the anethesetist came to see me & said I was lucky because he'd been working at a post mastectomy pain clinic &  had learned that a "12 hour pain block" was incredibly effective at reducing mastectomy pain. He was very confident & said it was a terrific option & not all anesthetists can do it. So I agreed. I sat up on the operating table, he stuck it in my back (not painful!) then they put me under. I am still amazed, but other than 1 routine shot of morphine at 10 pm (my surgery was at 4) I never took any pain medications, not even an advil, after I woke up from surgery. I literally had not one moment of pain ever. I couldn't believe it. If this is the same as the block you are talking about, go for it!!!  (the only pain I ever had was a fleeting 20 seconds when they took out my drainage tube about a month later - now THAT hurt! but was over in a flash.

skippyrcis, I had a paravertebral nerve block when I had my left mast/SNB a year ago.  It was an option offered by the "pain management team" at my cancer center.  Because of a scheduling problem, they didn't have time to administer the nerve block before my surgery, but they tracked me down in the recovery area afterward.

The anesthesiologist gave me 3 or 4 (?) "paravertebral" injections with a local anesthetic.  "Paravertebral" means the injections were alongside the spinal column where the spinal nerves come out.  He also inserted a very tiny gauge catheter under the skin against the spinal nerve that innervates the chest wall where my mast incision was located.  He hooked the tubing to a bag of local anesthetic (bupivacaine) and an i.v. monitor.

The anesthesiologist told me that the drip setup and catheter would adminster a tiny amount of local anesthetic to that spinal nerve, which would block sensation from my mast incision.  He said the other injections would wear off after a few hours, but the bupivacaine being administered through the catheter would keep my mast incision area numb for as long as the system was in place.

Now for the bottom line:  I would not choose to have a paravertebral block again.  I learned too late that the area of the mast incision being numbed by the bupivacaine drip was numb anyway--the nerves were cut during the surgery.  The skin and muscle were completely numb along and about 2 inches above and below the incision line, and they stayed that way for many months.

The only places where I had pain were farther above and below the mast incision.  Once the one-time injections wore off, those areas hurt like I'd been kicked by a horse.  The anesthesiologist had warned me that would happen, and my surgeon ordered Percocet to be given for pain after the surgery.  I had some trouble convincing the nurses that I was supposed to be getting an oral pain medication in addition to the catheter delivering the bupivacaine.  Once the surgeon confirmed her orders and the nurses brought the Percocet, I was fine.

otter 

skippyrcis, what were the complications of the paravertebral nerve block?  I'm sure I signed a consent form before they administered mine, but I was in that hazy, drug-induced fog right after surgery and I know didn't read the form I was signing.

Ever since then, I've had a spot partway down my back, just to the left of my spinal/vertebral column, that feels like it's bruised.  It's in exactly the same place as the catheter had been located.  That spot hurt a lot after I got home from my surgery, and it still hurts now.

otter 

skippyrcis, it's been exactly a year to the day (Feb. 5th) since my mastectomy/SNB.  The sore spot on my back really isn't a big deal, and I'm not even sure it's due to the bupivacaine injection or catheter.  And, in the grand scheme of things, the nerve block was an interesting experiment.

The bupivacaine injections and/or placement of the tiny catheter didn't cause the long-term numbness at my mast incision.  That numbness is a typical SE of the surgery when the nerves are cut or damaged.

otter 

I had two single mastectomies, first the cancer breast and then a couple of months later, the other one. I had paravertebral blocks both times. I was told this could lighten anesthesia and make pain meds unnecessary.

A word of caution: for some reason, the first time, they gave me pain meds anyway, right after surgery and then I realized I was on a pump/drip in the hospital room. I spent the evening vomiting and felt very out of it, though pain was minimal.

The second time I made a big deal in preop and before surgery that I wanted NO pain meds and that with the block I did not NEED pain meds. I woke in recovery feeling pretty darn normal and was walking around the hospital floor from the get go. No drowsy, out of it feelings and no nausea.

The pain relief for me lasted 2-3 days. There was pain, different pain after each procedure, but the block really helped early on and for the next week or two I took only a partial oxycodone once in the late afternoon, then just Tylenol.

I strongly recommend the paravertebral block but make sure that EVERYONE knows it means no pain meds, and put in writing too- that tends to make them compliant!

I had the nerve block and it was amazing. I remember sitting up on the operating table to have it done, but really nothing after that.

I woke up with zero pain. Zero. As in, when the nurse asked me about my pain level, I had to honestly respond, "zero."

I was given Tylenol in my drip but that was it. I was permitted to walk all around the hospital floor unassisted; I was not deemed a "fall" risk.

I went home the next day and took my dog for a long walk.

A big bonus per my anesthesiologist is that studies have shown these nerve blocks are actually beneficial in reducing bc recurrence as well. Something to do with limiting bodily inflammation because the nerves don't get inflamed.

And I realize that responding to a post that's 8 years old is likely irrelevant at this point, but, the point in pre-emptively numbing a site by blocking the nerve is to stop something called "wind-up". If you can stop a nerve from being stimulated (like by cutting it) it will stop that "pain" information going to the brain & spinal cord. Ever had a cavity in a tooth? How much did that hurt? When you got it repaired can you imagine the pain you would have experienced during & afterward if they didn't give you that injection of anesthetic before they started drilling down into the bone? Block the pain from reaching the spine & brain in the first place, and you decrease it by about 10X or more after the fact.

This is the same thing. Just because you can't feel it because you are asleep doesn't mean the pain pathways are not being stimulated, you just aren't conscious of the pain. But your nervous system is. Your heart rate will still go up, your respiratory rate will go up, and they will likely have to increase your anesthetic when something that would otherwise be painful occurs. And you will feel more pain & discomfort in the entire area when you wake up, not just the incision site - which will be numb due to cut nerves.

Pre-emptive analgesia is awesome! And it sounds like a lot of very positive experiences with it here. Thanks for your feedback.