Evidence to support the argument that
general anesthesia (GA) with paravertebral block (PVB) provides better
pain relief for
mastectomy patients than GA alone is contradictory. The aim of this study was to explore
pain and
analgesia after
mastectomy with or without PVB during acute inpatient recovery. A retrospective study was conducted in a single hospital providing specialist
cancer services in metropolitan Melbourne, Australia. We explored
pain and concomitant
analgesic administration in 80 consecutive women recovering from
mastectomy who underwent GA with (n = 40) or without (n = 40) PVB. A
pain management index (PMI) was derived to illustrate the efficacy of management from day of surgery (DOS) to postoperative day (POD) 3. Patients who reported no
pain progressively increased from DOS (n = 12, 15%) to POD 3 (n = 54, 67.5%). Most patients were administered
analgesics as a combination of
acetaminophen and a strong
opioid on DOS (n = 53, 66.2%), POD 1 (n = 45, 56.2%), POD 2 (n = 33, 41.2%), and POD 3 (n = 21, 26.2%). Less than 6% of patients on any POD were administered multimodal anlagesics. PMI scores indicate some
pain in the context of receiving weak and strong
opioids for GA patients and more frequent use of
nonopioid analgesics in PVB patients during recovery. These findings highlight the need for data describing patterns of
analgesic administration in addition to reports of
postoperative pain to determine the most effective means of avoiding
postoperative pain in patients who require
mastectomy.