MTP Block vs Paravertebral Block for Pain Relief in Breast Cancer Surgery

Overseen By Ioana Costache, MD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: Ottawa Hospital Research Institute

Must not be taking: Opioids

Disqualifiers: Prior breast surgery, Neuropathy, Chronic pain, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 1 day

150 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it excludes those with chronic opioid use. It's best to discuss your specific medications with the trial team.

What data supports the effectiveness of the MTP block treatment for pain relief in breast cancer surgery?

Research shows that thoracic paravertebral block (PVB), a similar treatment, can reduce chronic pain after breast cancer surgery and improve quality of life. Multiple studies found that PVB before surgery helps lessen long-term pain and discomfort. ^{1 2 3 4 5}

Is the MTP Block or Paravertebral Block safe for humans?

Research shows that Paravertebral Blocks (PVBs) are generally safe for pain management in breast surgery, with studies focusing on their effectiveness and safety. While specific safety data for MTP Blocks is not detailed, PVBs have been evaluated for adverse events and are considered safe in the context of breast surgery. ^{3 5 6 7 8}

How does the MTP block treatment differ from other treatments for pain relief in breast cancer surgery?

The MTP block treatment is unique because it involves a specific technique called the Mid-Point Transverse Process Pleura Block, which is compared to the more commonly used Paravertebral Block (PVB) for pain relief after breast cancer surgery. This approach may offer different benefits in terms of pain management and recovery, as it targets specific areas around the spine to block pain signals. ^{3 4 5 6 9}

What is the purpose of this trial?

This trial will compare a new pain relief method called MTP block to traditional methods for patients undergoing breast surgery. The MTP block aims to provide safer and easier nerve numbing to reduce pain.

Research Team

Ioana Costache, MD

Principal Investigator

Ottawa Hospital, Ottawa Hospital Research Institute

Eligibility Criteria

This trial is for English or French-speaking individuals scheduled for major breast surgery, with a BMI under 30 and an ASA physical status of I-III. It's not suitable for those who've had previous breast surgery on the same side, have nerve issues in the chest, can't have regional anesthesia, refuse this type of pain control, use opioids regularly, suffer from chronic pain disorders or cannot consent.

Inclusion Criteria

English or French Speaking

Scheduled for major breast surgery

You have a good to moderate overall health status.

Exclusion Criteria

You had surgery on the same side as your breast.

You already have a nerve problem or numbness in the chest on the same side as the treatment.

Contraindications to regional anesthesia

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either MTP block, PVB, or control treatment during breast cancer surgery

1 day

1 visit (in-person)

Post-operative Monitoring

Participants are monitored for postoperative analgesia and quality of recovery

48 hours

Follow-up

Participants are monitored for safety and effectiveness after treatment

1-2 weeks

Treatment Details

Interventions

• Control Group
• MTP block group
• PVB group

Trial Overview The study is testing how well a new pain-blocking procedure called MTP block works compared to no intervention (control) and another established method known as thoracic paravertebral block (PVB). Participants will be randomly assigned to one of these three groups during their breast cancer surgery.

Participant Groups

Group I: MTP block group Experimental Treatment 1 Intervention

MTP blocks with 0.5% ropivacaine and epinephrine 2.5 mcg/mL

Group II: PVB group Active Control 1 Intervention

paravertebral blocks with 0.5% ropivacaine and epinephrine 2.5 mcg/mL

Group III: control group Placebo Group 1 Intervention

local anesthetic infiltration subcutaneous 1% lidocaine

Who Is Running the Clinical Trial?

Ottawa Hospital Research Institute

Lead Sponsor

Trials

585

Recruited

3,283,000+

References

1. United States pubmed.ncbi.nlm.nih.gov

Thoracic paravertebral block for breast cancer surgery: a randomized double-blind study. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Thoracic paravertebral block and its effects on chronic pain and health-related quality of life after modified radical mastectomy. [2022]

3. New Zealand pubmed.ncbi.nlm.nih.gov

Preoperative ultrasound-guided multilevel paravertebral blocks reduce the incidence of postmastectomy chronic pain: a double-blind, placebo-controlled randomized trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Reducing persistent postoperative pain and disability 1 year after breast cancer surgery: a randomized, controlled trial comparing thoracic paravertebral block to local anesthetic infiltration. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Thoracic Paravertebral Blockade Reduces Chronic Postsurgical Pain in Breast Cancer Patients: A Randomized Controlled Trial. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

The Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Paravertebral Block and Mid-Point Transverse Process Pleura Block in Mastectomy Surgeries: A Randomized Study. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Improving Analgesic Efficacy and Safety of Thoracic Paravertebral Block for Breast Surgery: A Mixed-Effects Meta-Analysis. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Should thoracic paravertebral blocks be used to prevent chronic postsurgical pain after breast cancer surgery? A systematic analysis of evidence in light of IMMPACT recommendations. [2022]