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ESPB and paravertebral blocks provided comparable analgesia after breast cancer surgery

World journal of surgical oncology (PubMed)Aug 22, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A meta-analysis of randomized trials found erector spinae plane and thoracic paravertebral blocks produced comparable pain control and perioperative outcomes after breast cancer surgery.

What NurseJet pulled from the source

Nineteen randomized trials involving 1,527 patients compared erector spinae plane block with paravertebral block for breast cancer surgery. The groups did not differ significantly in postoperative morphine use, pain scores at rest or with movement, postoperative nausea and vomiting, intraoperative fentanyl use, rescue analgesia, or analgesia duration.

Why this matters for nurses

Oncology and postoperative nurses reassess pain, opioid exposure, nausea, and functional recovery after breast surgery. The review supports treating both blocks as potentially effective options while continuing individualized assessment rather than expecting one technique to eliminate rescue medication or symptoms.

Bedside takeaway

Expect similar overall analgesic outcomes with either block and continue structured pain, opioid, and nausea reassessment.

How This Applies in Practice

Use this when: Receiving or reassessing a patient after breast cancer surgery performed with an erector spinae plane or paravertebral block.

On your shift

Confirm the documented block and ordered multimodal analgesia plan during handoff.
Trend pain at rest and with movement, rescue medication use, sedation, and postoperative nausea or vomiting.
Escalate inadequate analgesia, unexpected sedation, or other protocol-defined postoperative concerns.

Keep in mind: The review does not make either block universally preferable. Follow the perioperative plan, facility protocol, and provider orders.

Key takeaways

The review pooled 19 randomized trials with 1,527 breast cancer surgery patients.
Postoperative morphine use and pain scores were comparable between the two regional-block techniques.
Postoperative nausea and vomiting, fentanyl use, rescue analgesia, and analgesia duration were also comparable.
The findings do not establish that one block is superior for postoperative analgesia.

Practice implications

Identify which block the patient received, trend pain at rest and with movement, document rescue analgesia and nausea, and escalate inadequate control or unexpected deterioration through the perioperative team’s pathway.

Limitations & cautions

The abstract reports pooled comparisons but does not describe heterogeneity, certainty of evidence, or complication rates in detail. Choice of block remains a procedural decision based on patient factors, clinician expertise, and local practice.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

Public citations are filtered to exact credible source pages. Homepage-only or invalid links stay in admin review and are not shown here.

World journal of surgical oncology (PubMed)

World journal of surgical oncology (PubMed). Erector spinae plane block (ESPB) versus paravertebral plane block (PVB) in managing post-operative pain in breast cancer patients: a systematic review and meta-analysis.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42632896/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

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In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

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Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

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AI-summarized from the linked source. Review the original article before applying to practice.

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In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

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Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

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At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
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Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

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Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

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European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

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Why this matters on shift

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Bedside takeaway

Ask caregivers about unmet information and support needs, then reinforce teaching with approved digital resources.

Nursing implications

Assess what caregivers still need to know and use approved digital education as a supplement to individualized teaching and follow-up.

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AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

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How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

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