الفهرس 
Chapter 1: Thoracic paravertebral blockOnly 14 pages are availabe for public view
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Abstract
Breast cancer is perhaps the most common cancer in women that requires frequent surgery(1). Nearly 40% of postoperative breast surgery patients experience significant acute postoperative pain with a pain score above 5 reflecting the inadequacy of conventional pain management (2). Most of to be detrimental to the patient’s homeostasis and recovery. Moreover the responses of the human body to postsurgical pain have been proven, the incidence of chronic postoperative pain in breast surgery patients is as high as 50% and inadequate analgesia is consideredas an independent risk factor (3). Hence, a number of therapeutic measures have been accepted as a part of the “multi-modal” approach to postoperative pain control.Thoracic paravertebral block (PVB) is used for pain relief after thoracotomy and mastectomy. PVB can provide profound, long-lasting sensory deafferentation. The resulting greater attenuation of surgical stress response may translate into reduced inotropic stress response of the heart (4). Additionally, unlike general anesthesia, PVB can provide superior postoperative analgesia, less nausea and vomiting, shorter recovery time, require fewer analgesic, earlier mobilization, and earlier home readiness for discharge(4). The use of PVB in patients undergoing ambulatory breast surgery has a cost-saving potential4. There is little systematic research on the efficacy and tolerability of the addition of an adjunctive analgesic agent in paravertebral analgesia. If quality and duration of analgesia of PVB can be improved by adding adjuvants to local anesthetic (LA), its benefits can be maximized (4).