{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:32:33Z","timestamp":1783006353631,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"1","funder":[{"name":"Region Zealand Health Science Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,4,25]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The intertransverse process (ITP) block mimics the thoracic paravertebral block and allegedly ameliorates hemithoracic postoperative pain. However, concerning major reconstructive breast cancer surgery the modality has never been tested against placebo in a randomized clinical trial. We aimed to assess the efficacy of the multiple-injection ITP block and hypothesized that the blockade would reduce postoperative opioid consumption.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We screened 58 patients with breast cancer scheduled for unilateral subpectoral implant-based primary breast reconstruction, involving mastectomy with complete fascial dissection of the major pectoral muscle. A randomization procedure allowed for the allocation of 36\u2009patients to receive either unilateral multiple-injection active ITP block (0.5% ropivacaine 3\u00d710\u2009mL) or placebo ITP block (isotonic saline 3\u00d710\u2009mL) at T2, T4, T6 in a prospective, blinded, clinical trial. The primary outcome was total opioid consumption within the first 24 postoperative hours. Secondary outcomes included opioid consumption at 4-hour intervals, postoperative pain, patient satisfaction with block application, time to first opioid, ambulation and discharge, opioid-related side effects, and quality of recovery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Opioid consumption within the first 24 postoperative hours showed no significant reduction when comparing the active and placebo group median (IQR): 75.0\u2009mg (45\u2013135) vs 62.5\u2009mg (30\u2013115), p=0.5, respectively. We did not find any consequential clinically relevant results of the secondary outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Following major reconstructive breast cancer surgery, a preoperative multiple-injection ITP block neither reduces 24-hour opioid consumption postoperatively nor promotes substantial clinical positive outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>EudraCT2019-001016-35.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104479","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T10:35:22Z","timestamp":1683801322000},"page":"10-16","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Insignificant influence of the intertransverse process block for major breast cancer surgery: a randomized, blinded, placebo-controlled, clinical trial"],"prefix":"10.1136","volume":"49","clinical-trial-number":[{"clinical-trial-number":"nct04248179","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3764-0445","authenticated-orcid":false,"given":"Martin Vedel","family":"Nielsen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8086-5757","authenticated-orcid":false,"given":"Katrine","family":"Tanggaard","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lone Bak","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1719-9402","authenticated-orcid":false,"given":"Christian Kruse","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojgan","family":"Vazin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9839-3812","authenticated-orcid":false,"given":"Jens","family":"B\u00f8rglum","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"2025101110411033000_49.1.10.1","unstructured":"Dixon M . Breast surgery. A companion to specialist surgical practice. 5th ed. Amsterdam: Saunders Elsevier, 2014."},{"key":"2025101110411033000_49.1.10.2","unstructured":"Danish Breast Cancer Group . Kirurgisk behandling AF brystkr\u00e6ft [online]. 2022. Available: https:\/\/www.dmcg.dk\/Kliniske-retningslinjer\/kliniske-retningslinjer-opdelt-paa-dmcg\/brystcancer\/kirurgisk-behandling-af-brystkraft\/ [Accessed 6 Apr 2023]."},{"key":"2025101110411033000_49.1.10.3","article-title":"Breast cancer surgery and a standardized perioperative pain treatment regimen-opportunities for improvement","volume":"43","author":"Nielsen","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"2025101110411033000_49.1.10.4","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1111\/aas.13424","article-title":"Are single-injection erector spinae plane block and multiple-injection costotransverse block equivalent to thoracic paravertebral block?","volume":"63","author":"Nielsen","year":"2019","journal-title":"Acta Anaesthesiol Scand"},{"key":"2025101110411033000_49.1.10.5","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2020-102451"},{"key":"2025101110411033000_49.1.10.6","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2020-101583"},{"key":"2025101110411033000_49.1.10.7","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1111\/anae.14004","article-title":"The mid-point transverse process to pleura (MTP) block: a new end-point for thoracic paravertebral block","volume":"72","author":"Costache","year":"2017","journal-title":"Anaesthesia"},{"key":"2025101110411033000_49.1.10.8","doi-asserted-by":"crossref","first-page":"2432","DOI":"10.1053\/j.jvca.2021.12.036","article-title":"Single-Injection midpoint transverse process-to- pleura block versus thoracic paravertebral block for postoperative analgesia after uniportal video-assisted thoracoscopic surgery: a randomized controlled trial","volume":"36","author":"Chen","year":"2022","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025101110411033000_49.1.10.9","doi-asserted-by":"crossref","first-page":"512","DOI":"10.4103\/ija.IJA_64_21","article-title":"Comparison of analgesic efficacy of the conventional approach and mid-transverse process to pleura approach of the paravertebral block in video-assisted thoracoscopy surgeries: a randomised controlled trial","volume":"65","author":"Swathi","year":"2021","journal-title":"Indian J Anaesth"},{"key":"2025101110411033000_49.1.10.10","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1080\/08941939.2022.2098544","article-title":"The comparison of postoperative analgesic efficacy of ultrasound-guided paravertebral block and mid-point transverse process pleura block in mastectomy surgeries: a randomized study","volume":"35","author":"Kahramanlar","year":"2022","journal-title":"J Invest Surg"},{"key":"2025101110411033000_49.1.10.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-022-01651-3","article-title":"Use of ultrasound guided single shot costotransverse block (intertransverse process) in breast cancer surgery: a prospective, randomized, assessor blinded, controlled clinical trial","volume":"22","author":"Aygun","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"2025101110411033000_49.1.10.12","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2022-104003"},{"key":"2025101110411033000_49.1.10.13","doi-asserted-by":"crossref","DOI":"10.1186\/1741-7015-8-18","article-title":"Consort 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"8","author":"Schulz","year":"2010","journal-title":"BMC Med"},{"key":"2025101110411033000_49.1.10.14","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1111\/aas.14018","article-title":"Ultrasound-Guided multiple-injection costotransverse block for mastectomy and primary reconstructive surgery. 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