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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine the most effective pain relief for individuals undergoing major breast cancer surgery. It compares two nerve block types, the MTP block and the paravertebral block, with a standard pain relief method. The goal is to identify which method offers the best pain relief after surgery. This trial may suit those scheduled for major breast surgery, who speak English or French, and have a BMI under 30. As an unphased trial, it provides a unique opportunity to contribute to research that could enhance pain management for future patients.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that both the Midpoint Transverse Process to Pleura (MTP) block and the Paravertebral Block (PVB) are generally safe for managing pain after breast surgery. Studies have found that the MTP block is effective and well-tolerated, providing pain relief similar to the PVB.

For the PVB, evidence suggests it offers good pain control with few side effects. Many patients have used it successfully without major problems.

Overall, both treatments are considered safe and effective for managing pain after breast surgery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the MTP block and PVB techniques for pain relief in breast cancer surgery because they offer targeted pain management directly at the nerve level, which can potentially provide more effective and longer-lasting relief compared to traditional methods. Most standard treatments rely on general anesthetics or systemic medications, but these new techniques use a specific combination of 0.5% ropivacaine and epinephrine to block pain at the nerve source. This focused approach could reduce the need for systemic pain medications, which often come with undesirable side effects. Additionally, by directly blocking nerve signals, patients might experience quicker recovery times and improved overall comfort post-surgery.

What evidence suggests that this trial's treatments could be effective for pain relief in breast cancer surgery?

This trial will compare the effectiveness of MTP blocks and paravertebral blocks (PVB) for pain relief in breast cancer surgery. Research has shown that the MTP block, one of the treatments in this trial, reduces pain after surgery and lowers pain levels more effectively than basic local anesthetics. However, some reports suggest patients might experience slightly more pain when moving and may require additional painkillers soon after surgery.

Paravertebral blocks (PVB), another treatment option in this trial, also effectively relieve pain after breast surgery. Research indicates that PVB reduces postoperative pain and performs as well as epidural anesthesia. Additionally, PVB can reduce long-term postoperative pain by nearly half. Both treatments offer promising options for managing pain after breast cancer surgery. ^{1 5 6 7 8}

Who Is on the Research Team?

Ioana Costache, MD

Principal Investigator

Ottawa Hospital, Ottawa Hospital Research Institute

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12538660/

Safety and Efficacy of Ultrasound-Guided Retrolaminar and ... Our pooled analysis revealed that MTP block and RLB offer early postoperative analgesic efficacy comparable to PVB. However, the MTP block/RLB ...

2. academic.oup.com academic.oup.com/painmedicine/article/19/8/1650/4653144

Identification of Myofascial Trigger Points in Breast Cancer ... Effect of myofascial techniques for treatment of persistent upper limb pain after breast cancer treatment: Randomized controlled trial.

3. tandfonline.com tandfonline.com/doi/full/10.1080/11101849.2023.2231709

Full article: Analgesic efficacy of pre-emptive ultrasound ... The results showed that MTP block effectively reduced postoperative pain compared to the control group. In the present study, there was a significant ...

4. cureus.com cureus.com/articles/405840-safety-and-efficacy-of-ultrasound-guided-retrolaminar-and-midpoint-transverse-process-to-pleura-blocks-compared-to-ultrasound-guided-classic-paravertebral-block-for-breast-and-thoracic-surgery-a-systematic-review-and-meta-analysis

Safety and Efficacy of Ultrasound-Guided Retrolaminar and ... However, the MTP block/RLB group tended to have slightly higher pain scores with movement and greater cumulative opioid consumption in the first ...

5. journals.lww.com journals.lww.com/joacp/fulltext/2024/40020/comparison_of_midpoint_transverse_process_to.25.aspx

Comparison of midpoint transverse process to pleura (MTP)... Kaur et al. mentioned that the MTP block could be successfully used in chest trauma patients for pain relief. Another case report by Pedoto et al. cited the ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT03713255

Mid-point Transverse Process to Pleura Block for Breast ... This study will compare the analgesic effects of midpoint transverse process to pleura (MTP) block to control as well as thoracic paravertebral block.

7. withpower.com withpower.com/trial/phase-breast-neoplasms-2020-73c6b

MTP Block vs Paravertebral Block for Pain Relief in Breast ... Research shows that Paravertebral Blocks (PVBs) are generally safe for pain management in breast surgery, with studies focusing on their effectiveness and ...

8. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/35848451/

The Comparison of Postoperative Analgesic Efficacy ... It was concluded that ultrasound-guided PVB and MTP blocks have similar postoperative analgesic efficacy in patients undergoing breast surgery.