Cancer Treatment

Pain Management: Alternative to Narcotics for Breast Surgery

Q & A with Dr. Vivek Iyer, Interventional Pain Management Specialist at Cancer Treatment Centers of America

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Question: Why is managing pain such an important part of cancer treatment?

Answer: According to the National Cancer Institute, pain is one of the most common symptoms cancer patients face. Studies have shown that reducing or controlling the level of pain patients experience may lead to better outcomes. Patients also have a tendency to heal more quickly. Pain management is essential in maintaining a patient’s quality of life throughout cancer treatment.

Question: If I am undergoing breast cancer surgery, what are my options for alleviating pain?

Answer: Traditionally, following surgery, doctors give patients narcotic pain medication through an IV to manage their pain. When the patient goes home, many of them are prescribed that same narcotic in a pill form. Patients are also able to receive higher doses of non-opioid medications to control pain and inflammation, such as ibuprofen or naproxen sodium. For some breast cancer patients, at Cancer Treatment Centers of America® (CTCA), we are working to avoid the use of narcotic pain medication by utilizing a procedure called paravertebral nerve blocks. This procedure temporarily blocks nerves that send pain signals to the brain, thereby reducing pain without the use of narcotics. By using this procedure we can reduce narcotic pain medication usage and, therefore, we can potentially eliminate the side effects that often come along with narcotics, which may include nausea, constipation, drowsiness, or even addiction.

Question: Can you explain more about the paravertebral blocks and how long it takes to insert?

Answer: The paravertebral blocks are inserted just before a patient’s breast cancer surgery. By using an ultrasound machine, the physician is able to identify the paravertebral space on a patient’s back and position the catheter appropriately. During this time, the patient is lying down on a stretcher, with their back arched and neck flexed. Depending on the surgery, placing the catheter may take anywhere from 10 to 15 minutes. The catheter is then connected to a ball, which continuously drips local anesthetic or numbing medication into the desired location. This will help block pain for three to four days following surgery.  Patients may even return home with this catheter and ball, enabling them to return to their everyday lives more quickly.

Question: What are some of the potential benefits of paravertebral blocks?

Answer:  One of the greatest benefits of this procedure is the alleviation of pain following surgery, sometimes without the use of narcotics. Patients are able to leave the hospital sooner to go home and rest, having the same level of pain control as they did at the hospital, thereby improving their overall recovery time.

In a study entitled, The Role of Paravertebral Block in Decreasing Postoperative Pain in Elective Breast Surgeries, the author measured the effectiveness of paravertebral blocks as a regional anesthesia technique, compared to general anesthesia for postoperative pain. The patients who received the paravertebral blocks were found to have better postoperative pain relief, reduced need for morphine and a shorter hospital stay compared with general anesthesia alone.

 Question: Are there any side effects to using paravertebral blocks?

Answer: Side effects for this procedure are limited; however, there is a rare risk of infection that may be caused by the catheter. Paravertebral blocks have also been widely used and publicized for thoracic surgeries. In the study, Analgesia for Thoracic Surgery: The Role of Paravertebral Block, the authors shared how a “paravertebral block has a better safety profile when compared to intravenous (IV) and thoracic epidural analgesia”.    

Question: What feedback have you received from patients who have used paravertebral blocks?

Answer: So far, the patients whom I have performed this procedure on at CTCA® have reported positive results. Not only were these patients able to reduce narcotics – and their side effects – during their recovery period, but they were also able to reduce their hospital stays following surgery. This allowed patients to spend more time with family and friends and, ultimately, get back to their day-to-day lives more quickly.

Vivek Iyer, MD is the Interventional Pain Management Specialist at Cancer Treatment Centers of America at Western Regional Medical Center in Goodyear, Arizona.