Anesthesia For Breast Surgery Research Articles

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

The spread of injectate after deep serratus anterior plane and superficial parasternal intercostal plane blocks: a cadaveric dye study.

We investigated the distribution of injected dye after deep serratus anterior plane and superficial parasternal intercostal plane blocks in 15 Thiel embalmed cadavers. We injected 0.4 ml.kg-1 of 0.25% aqueous methylene blue solution into the deep serratus anterior and superficial parasternal intercostal planes using real-time ultrasound needle visualisation followed by posterior dissection to observe the distribution of the injected dye in the chest wall. The two blocks were performed bilaterally in 15 cadavers at the T5/T6 level, comprising 60 blocks in 30 hemithoraces in total. At dissection, the intercostal nerve territories were observed to be dyed completely from T2 to T6 in 28 of 30 hemithoraces, and extending caudal to T6 in 10 hemithoraces. Following the deep serratus anterior plane blocks in all cadavers, the dye was found to have spread to the axillae. Following the superficial parasternal intercostal plane blocks, the dye reached T7 in four cadaver dissections. We concluded that the territories innervated by the intercostal nerves (T2-T6 dermatomes) are dyed following the combination of the two blocks when performed at the T5-T6 intercostal space level. These techniques might provide an effective option for anaesthesia in breast surgery.

Regional Block Anesthesia in Breast Surgery: What Do We Know So Far?

Regional Block Anesthesia in Breast Surgery: What Do We Know So Far?

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

BackgroundBreast surgery in the United States is common. Pain affects up to 50% of women undergoing breast surgery and can interfere with postoperative outcomes. General anesthesia is the conventional, most frequently used anaesthetic technique. Various locoregional anesthetic techniques are also used for breast surgeries. A systematic review of the use of locoregional anesthesia for postoperative pain in breast surgery is needed to clarify its role in pain management.ObjectivesTo systematically review literature to establish the efficacy and the safety of locoregional anesthesia used in the treatment of pain after breast surgery.MethodsEmbase, MEDLINE, Google Scholar and Cochrane Central Trials Register were systematically searched in Mars 2020 for studies examining locoregional anesthesia for management of pain in adults after breast surgery. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively.ResultsNineteen studies evaluating locoregional anesthesia were included: 1058 patients underwent lumpectomy/mastectomy, 142 breast augmentation and 79 breast reduction. Locoregional anesthesia provides effective anesthesia and analgesia in the perioperative setting, however no statistically significant difference emerged if compared to other techniques. For mastectomy only, the use of locoregional techniques reduces pain in the first hour after the end of the surgery if compared to other procedures (p = 0.02). Other potentially beneficial effects of locoregional anesthesia include decreased need for opioids, decreased postoperative nausea and vomiting, fewer complications and increased patient satisfaction. All this improves postoperative recovery and shortens hospitalization stay. In none of these cases, locoregional anesthesia was statistically superior to other techniques.ConclusionThe results of our review showed no differences between locoregional anesthesia and other techniques in the management of breast surgery. Locoregional techniques are superior in reducing pain in the first hour after mastectomy.

A possible future for anaesthesia in breast surgery: thoracic paravertebral block and awake surgery. A prospective observational study.

Quadrantectomy is a surgical procedure traditionally performed under general anaesthesia with intraoperative and postoperative opioid-based analgesia. The use of locoregional anaesthesia techniques in breast surgery has become widespread and allows excellent management of intraoperative and postoperative pain with reduced opioid consumption. We chose thoracic paravertebral block as regional anaesthesia technique in breast surgery to investigate the possibility of carrying out this surgery with the patient awake. A prospective observational study on 50 patients was designed. The primary outcome for this study was the possibility to carry out the surgery with only the paravertebral block associated with mild sedation without general anaesthesia. Forty minutes before the start of the surgery, an ultrasound-guided thoracic paravertebral block was performed at two thoracic levels, and for each level, 7 mL of ropivacaine 0.7% was injected. Sedation was obtained with target-controlled infusion of propofol. Forty-nine patients underwent the operation awake; in one case, we had to place an I-gel and perform general anaesthesia. No patient needed intraoperative or postoperative opioids. The numeric rating scale, recorded at 0, 2, 6, 12, 24, and 36 hours, was greater than 3 in only five patients. We believe that if in the future we try to make quadrantectomy an intervention in which the anaesthesia is exclusively regional, therefore with a patient awake and collaborating, it will not be possible to ignore the use of thoracic paravertebral block.

Pectoral nerves blocks (PECS) and sedation: A way to avoid general anesthesia in breast surgery - A single institution early experience.

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Regional Anesthesia for Breast Surgery

Regional Anesthesia for Breast Surgery

The application of thoracic paravertebral blockade

Background Thoracic paravertebral blockade(TPVB) is a regional nerve blocking technique by injecting local anesthetics into thoracic paravertebral space, adjacent to the intervertebral foramina, to block the roots of thoracic nerves. This technique can be performed under the guidance of anatomical markers or ultrasound, and has been widely applied in thoracic and abdominal surgeries for postoperative pain management. Objective To summarize anatomical basis and clinical application of TPVB. Content The injection sites of TPVB are located near thoracic paravertebral space(TPVS), which can be identified with traditional and ultrasound-assisted methods. The local anesthetics including bupivacaine, lidocaine, and ropivacaine, were administered with TPVB to relieve pain in one-sided thoracic and abdominal surgeries and chronic pain syndromes, and also to perform anesthesia in breast surgery. With satisfying analgesic and anesthetic effects, TPVB has less adverse effects than epidural and intravertebral anesthesia, and interpleural blockade. Trend TPVB under the guidance of ultrasound provides a safe drug injection technique for multimodal analgesia with similar efficacy to epidural and intravertebral injection, but less adverse effects. Further investigations are required to expand its application and to prevent related complications. Key words: Thoracic paravertebral block; Regional anesthesia; Technique pharmacokinetics; Complication

Comparative Study between Continuous Thoracic Epidural vs. Thoracic Spinal Anaesthesia in Breast Surgery

Objective: The aim of this work is to compare between thoracic epidural anesthesia (TEA) and segmental thoracic spinal anesthesia (TSA) conducted for breast surgeries as regard to hemodynamic changes (blood pressure, heart rate, oxygen saturation, ETCO2), postoperative pain control, postoperative analgesic requirements, surgeon satisfaction, postoperative ambulation time and perioperative complication. Setting: Al-Hussein and Sayed Galal hospitals. Patients and Methods: This work was done upon 40 female patient undergoing breast surgeries. Patients were divided randomly into 2 equal groups according to the type of anesthetic technique had been chosen. Group I were anaesthetized by thoracic epidural anesthesia and group II by segmental thoracic spinal anesthesia. Results: Recovery and ambulation time was more or less equal in the both groups. This is important since the patient can readily return to her family and social environment and can decrease the cost of the procedure, although this was not specifically assessed in this study. Post-operative pain was compared at the time 0, 1, 2, 4 and 8 hour by using VAS. Conclusion: We found that epidural blockade a preferred choice of anesthetic management for breast surgery.

Abstract P2-18-17: Breast cancer surgery for the elderly - Are we meeting a growing need?

Abstract Background≤br≥Between 2002 and 2011, in the UK, the number of people aged 90 increased by 26%. By 2034 the number of people aged 85 and over, is projected to be 2.5 times larger than in 2009. Life expectancy of 80 year old woman is now 9.4 years. These population statistics bring challenges to the provision of healthcare in general and Breast Cancer Services will see a significant increase in the number of very elderly patients. Prior to 2009 it was common place to treat patients aged over 80 with endocrine therapy alone, avoiding surgery, however as the general life expectancy for this age group has improved this is no longer recommended management. NICE guidelines issued in February 2009 recommend surgery for breast cancer where possible over endocrine treatment We aim to review the proportion of patients presenting with breast cancer aged over 80, assess their management and survival during a 12 year period and audit patients presenting after 2009 against NICE guideline to explore reasons for noncompliance. Methods We have conducted a retrospective audit of all patients presenting with breast cancer to a single high-volume center from 2000-2012. Patients were identified from a comprehensive departmental database recording patient demographics as well as treatment modality. For patients treated after 2009, case records were accessed to assess the reasons for omitting surgery. One-tailed Fisher's Exact Test used throughout to calculate p-values. Results≤br≥5446 patients were treated at our unit from 2000-2012 with the over 80's comprising 6.0-8.7% p.a. This age group increased over time by 29% from 6.5% in 2000-2003 to 8.4% (p = 0.0001) in 2009-2012. The population aged 90 or over increased by around 50% from 1.7% to 2.6% (p = 0.06) in the same period. The table below shows changes in the proportion of patients offered surgery before and after the 2009 guidelines. Patients Undergoing Breast Cancer SurgeryPatients aged 80-89Patients aged 90 and over2000- 20082009-2012p-value2000-20082009-2012p-value267/396 (67%)172/230 (75%)0.0318/64 (28%)21/47 (44%)0.05 Following introduction of regional anaesthesia without General Anasthesia in 2011, the proportion of patients aged over 90 having surgery, increased further to 16/25 (64% p-0.0031). In the 10 year period from 2001-2010 the mastectomy rate was 60% in the over 80's and 45% in the over 90 year old, however this difference was not statistically significant (p = 0.29). We have accurate survival data for 396 patients who died during follow up. No patients died within 12 months of surgery. The median survival was 40 months following surgery and 27 months for patients treated with primary endocrine therapy. 16/218 patients aged 80-89 and 2/111 patients aged over 90 at diagnosis required resectional surgery after relapse on primary endocrine therapy. Of patients not having surgery after 2009, 48 were deemed unfit and 36 declined surgery. Conclusions≤br≥The elderly is a growing part of our population of breast cancer patients. We have increased the proportion of elderly patient having surgery in line with NICE guidance, partly due regional anaesthesia for breast surgery and modification of care pathways. The relapse rate following primary endocrine therapy was very low in the most elderly patients. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-17.

Bispectral index score (BIS) and level of cortisol response with different types of anaesthesia in breast surgery

Vojinovic-Golubovic, V.; Malenkovic, V.; Nedic, O.; Sopta, J.; Mitrovic, L. Author Information

Field block

Field block

Anaesthesia for breast surgery

surgery, there are numerous others: for example, benign lump excision, abscess incision and drainage, breast reduction or augmentation, and reconstructive procedures after mastectomy. Breast cancer is the most frequent cancer in women and is responsible for 20% of cancer deaths; its incidence in women > 50 years is 1 in 400 per year. Its prevalence has increased dramatically due to improved survival and introduction of screening programmes. Risk factors for breast cancer include age, environment, earlier menarche and later menopause, age at first pregnancy, family history, previous benign breast disease, radiation, life-style (diet, weight, alcohol intake), oral contraceptives and hormone replacement therapy. Some 5–8% of breast cancers are genetic, the associated genes being BRCA-1, BRCA-2 and P53.

Postoperative nausea and vomiting. A comparison between intravenous and inhalation anaesthesia in breast surgery

Nausea and vomiting during the first 24 postoperative hours after breast surgery were studied. Ninety patients scheduled for elective breast surgery were randomly assigned to one of three anaesthetic methods: total intravenous anaesthesia with propofol, or propofol or thiopental for induction followed by isoflurane anaesthesia. All three groups received fentanyl for peroperative analgesia. A total of 46 (51%) patients experienced emetic sequelae: 19 (21%) complained about nausea and another 27 (30%) vomited once or more during the postoperative course. More than 50% of the patients with nausea and 70% with vomiting first suffered from these symptoms in the surgical wards after leaving the postoperative unit. Nausea and vomiting were seen in 18 (60%), 13 (43%) and 15 (50%) for the groups propofol-propofol, propofol-isoflurane and thiopental-isoflurane, respectively. In conclusion, every second patient experienced nausea or vomiting after breast surgery, the majority of these emetic symptoms occurring after leaving the postoperative unit. Propofol for induction or as a main anaesthetic did not make any major difference with regard to postoperative nausea or vomiting.