Paravertebral Catheter for Three-Level Injection in Radical Mastectomy: A Randomised Controlled Study

Authors: Petchara Sundarathiti, Benno von Bormann, Ronnarat Suvikapakornkul, Panuwat Lertsithichai, Vanlapa Arnuntasupakul



Paravertebral block (PVB) is an alternative to general anaesthesia (GA) for breast surgery. However, for extensive surgery multiple punctures are needed increasing the immanent risk of the method. The purpose of this study was to evaluate PVB via catheter and injections at three different levels. Primary outcome was the quality of postoperative analgesia, in particular, the number of patients requiring additional morphine.


In a randomised single blinded clinical study patients scheduled for breast surgery including axillary approach, were randomly allocated to different anaesthetic techniques, n = 35 each. Patients received either GA with sevoflurane or PVB with catheter at level Th 4. In PVB-patients a 1:2 mixture of bupivacaine 0.5% and lidocaine 2% with adrenaline was injected sequentially 10 ml each at three different levels.


Complication-free catheter insertion was possible in all 35 scheduled patients. The need for postoperative analgesics was higher after GA compared to PVB (22 vs.14 patients); p = 0.056. Postoperative morphine consumption was 1.55 (GA) and 0.26 mg (PVB) respectively (p < 0.001). Visual rating score (VRS) for pain at rest and at movement was higher in GA patients on post anaesthesia care unit (PACU) as well as on the ward at 1 - 6h and 6 - 12h. Readiness for discharge was earlier after PVB (4.96 and 6.52 hours respectively). After GA the incidence and severity of postoperative nausea and vomiting (PONV) was higher, though not significantly. Patients’ satisfaction was comparable in both groups.


Three-level injection PVB via catheter for extensive mastectomy was efficient and well accepted. Using a catheter may enhance safety by avoiding multiple paravertebral punctures when extended spread of analgesia is required.

Citation: Sundarathiti P, von Bormann B, Suvikapakornkul R, Lertsithichai P, Arnuntasupakul V (2015) Paravertebral Catheter for Three-Level Injection in Radical Mastectomy: A Randomised Controlled Study. PLoS ONE 10(6): e0129539. doi:10.1371/journal.pone.0129539

Academic Editor: Sudeep Gupta, ACTREC (Advanced Centre for Treatment, Research and Education in Cancer) / Tata Memorial Centre, INDIA

Received: January 25, 2015; Accepted: May 7, 2015; Published: June 9, 2015

Copyright: © 2015 Sundarathiti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors have no support or funding to report.

Competing interests:

The authors have declared that no competing interests exist.


We thank Kawintra Yuwapattanawong M.D., Poonyanuch Srisakvarakul M.D., Rungrawan Buachai R.N., Theerawat Chalacheewa M.D., Yodying Wasutit M.D. and Rojnarin Komonhirun M.Ed., Faculty of Medicine, Ramathibodi Hospital, Mahidol University, for sharing their experiences with us. We thank Dr. Daniel Bressington, Senior lecturer, Canterbury Christ Church University, UK, for proof-reading this manuscript.

Author Contributions

Conceived and designed the experiments: PS BvB. Performed the experiments: PS PL. Analyzed the data: PS BvB. Contributed reagents/materials/analysis tools: RS PL VA. Wrote the paper: PS BvB.