mastectomy and anaesthesia

Aman Malawat, Kalpana Verma, Durga Jethava, Dharam D Jethava
Background and Aims: Several regional anaesthesia techniques have been described for carcinoma of the breast surgeries in the past but all of them failed to provide adequate surgical anaesthesia and are associated with multiple complications, thus limiting their use. This prospective study was designed to assess the efficacy of erector spinae plane (ESP) block to provide complete surgical anaesthesia without general anaesthesia (GA) and postoperative analgesia in patients undergoing modified radical mastectomy (MRM) surgery...
February 2020: Indian Journal of Anaesthesia
Sina Grape, Kariem El-Boghdadly, Eric Albrecht
STUDY OBJECTIVE: Due to conflicting results published in the literature regarding the analgesic superiority between the paravertebral block and the PECS block, the study objective is to determine which one should be the first line analgesic treatment after radical mastectomy. DESIGN: Systematic review, meta-analysis and trial sequential analysis. SETTING: Operating room, postoperative recovery area and ward, up to 24 postoperative hours. PATIENTS: Patients scheduled for radical mastectomy under general anaesthesia...
February 26, 2020: Journal of Clinical Anesthesia
Sina Grape, Eric Jaunin, Kariem El-Boghdadly, Vincent Chan, Eric Albrecht
STUDY OBJECTIVE: To determine whether pectoral nerves (PECS) blocks provide effective postoperative analgesia when compared with no regional technique in patients undergoing breast surgery. DESIGN: Systematic review, meta-analysis and trial sequential analysis. SETTING: Operating room, postoperative recovery area and ward, up to 24 postoperative hours. PATIENTS: Patients undergoing breast surgery under general anaesthesia with either PECS block or no regional technique...
February 25, 2020: Journal of Clinical Anesthesia
Moustafa A Moustafa, Ahmad S Alabd, Aly M M Ahmed, Ehsan A Deghidy
Background and Aims: Regional analgesia may play a role in pain management during breast surgery. Ultrasound approach to paravertebral block may be challenging. This study compared success rates of ultrasound-guided erector spinae plane block (ESPB) versus parasagittal in-plane thoracic paravertebral block among senior anaesthesia residents in modified radical mastectomy. Methods: One hundred and two female patients undergoing modified radical mastectomy were randomly categorized into PARA group receiving sagittal in-plane paravertebral block and ESPB group receiving erector spinae plane block...
January 2020: Indian Journal of Anaesthesia
Fabricio T Mendonça, Douglas Pellizzaro, Breno J Grossi, Luise A Calvano, Luiz S F de Carvalho, Andrei C Sposito
BACKGROUND: Recently, the use of venous adjuvants, such as lidocaine and magnesium sulfate, has been gaining ground in multimodal analgesia. However, no study has evaluated the impact a combination of the two drugs. OBJECTIVES: To evaluate the efficacy of venous adjuvants in reducing opioid consumption and pain scores after mastectomy. DESIGN: Randomised, double-blind, parallel-group, noninferiority clinical trial with a 1 : 1 : 1 : 1 allocation ratio...
March 2020: European Journal of Anaesthesiology
Ashleigh Bell, Oroog Ali, Amy Robinson, Amitabh Aggarwal, Michael Blundell, Alice Townend, Sebastian Aspinall
Background: It is now recognised that the majority of breast surgery can be safely undertaken as day case procedures. We aimed to evaluate the effect of pectoral nerve (Pecs2) blocks on recovery parameters and day case rates in patients undergoing mastectomy for breast cancer. Methods: A prospective cohort study was performed in a single NHS Foundation trust between 1st April 2014 and 31st December 2016. Visual analogue scale (VAS) pain scores (0-10) at 4 and 8 h, episodes of post-operative nausea ± vomiting (PONV), opioid use and day case outcome were compared between Pecs2 and no Pecs2 groups...
December 2019: Annals of Medicine and Surgery
Chandni Sinha, Amarjeet Kumar, Ajeet Kumar, Chandrakant Prasad, Prashant Kumar Singh, Diti Priya
Background and Aims: Patients undergoing breast cancer surgeries face significant post-operative pain. We aimed to compare pectoral nerve (PECS) block with erector spinae (ESP) block in these patients in terms of analgesic efficacy and adverse effects. Methods: Sixty four American Society of Anesthesiologists' status I and II female patients between age 18 to 60 years scheduled for unilateral modified radical mastectomy (MRM) under general anaesthesia, were enrolled in this prospective randomised study...
August 2019: Indian Journal of Anaesthesia
Muhammad Nadeem, Ajay Sahu
BACKGROUND: Breast cancer surgery under local anaesthesia (LA) can be challenging due to limitation of dose and quantity of anaesthetic agent that can be used safely. Elderly patients with breast cancer and with multiple co-morbidities are often prevented from having a standard treatment as they are considered unfit for general anaesthesia. We describe a technique of surgery under local anaesthesia without sedation that employs dilution to generate large volumes of LA and infiltration under ultrasound guidance...
August 22, 2019: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Nantthasorn Zinboonyahgoon, Kamen Vlassakov, Philipp Lirk, Tara Spivey, Tari King, Laura Dominici, Mehra Golshan, Gary Strichartz, Robert Edwards, Kristin Schreiber
BACKGROUND: Previous studies suggest that truncal regional anaesthesia (TRA), including techniques such as paravertebral block, may contribute significantly to analgesia after mastectomy. However, the severity and impact of postoperative pain varies markedly amongst individuals, making the identification of patients who would benefit most from TRA a potentially important step toward personalised perioperative care. METHODS: In this prospective observational study, mastectomy patients (n=122) were recruited and systematically assessed for psychosocial characteristics including pain catastrophising before surgery, and either received preoperative TRA (n=57) or no block (n=65)...
August 2019: British Journal of Anaesthesia
Simon FitzGerald, Peter M Odor, Ann Barron, Amit Pawa
Regional anaesthesia techniques are an important adjunct to perioperative care of breast surgery patients. This chapter focuses on the practical application, evidence base and advantages of peripheral nerve block regional anaesthesia in the anaesthetic management of patients undergoing breast surgery. Functional anatomy and fascial plane blocks are discussed alongside paravertebral and paraspinal techniques. Guidance on the performance the range of ultrasound-guided blocks is provided. The role that regional anaesthesia may have in reducing the risk of breast cancer recurrence following mastectomy surgery is explored...
March 2019: Best Practice & Research. Clinical Anaesthesiology
Onur Selvi, Serkan Tulgar
Erector spinae plane (ESP) block is a recently described regional anaesthesia/analgesia technique. Although there is stil no consensus on its mechanism, the published case series seem to promise a new block for both chronic and acute pain. In this case report, the use of ESP block in 47-year-old female patient scheduled for bilateral segmental mastectomy surgery is presented. ESP was formerly reported for rib fracture, bariatric surgery, open abdominal surgery and breast implant surgery. To the best of our knowledge, no article has been published for ESP block in breast cancer surgery including axillary dissection...
April 2019: Turkish Journal of Anaesthesiology and Reanimation
Rakhi Khemka, Arunangshu Chakraborty
Ultrasound-guided serratus anterior plane (SAP) block has been described to provide complete anaesthesia and analgesia to the lateral thoracic wall. Its use has been recently reported in breast reconstruction surgeries. We present a series of 11 patients where ultrasound-guided SAP block was used as part of multimodal analgesia in breast reconstruction surgery using latissimus dorsi (LD) myocutaneous flap after mastectomies. This resulted in excellent analgesia in the perioperative period and minimal use of intravenous analgesics...
March 2019: Indian Journal of Anaesthesia
Swati Singh, Gunjan Kumar, Akhileshwar
Background and Aims: Several locoregional techniques have been described for providing postoperative analgesia after breast surgery. The optimal technique should be easy to perform, reproducible and provide good analgesia. This randomised control study was designed to evaluate the postoperative analgesic effect of ultrasound-guided erector spinae plane (US-guided ESP) block for modified radical mastectomy (MRM) surgery. Methods: A total of 40 females belonging to American Society of Anesthesiologists' 1 or 2 posted for MRM were randomly allocated into Group 1 (control group) and group 2 (ESP group)...
March 2019: Indian Journal of Anaesthesia
Elina Cv Brinck, Elina Tiippana, Michael Heesen, Rae Frances Bell, Sebastian Straube, R Andrew Moore, Vesa Kontinen
BACKGROUND: Inadequate pain management after surgery increases the risk of postoperative complications and may predispose for chronic postsurgical pain. Perioperative ketamine may enhance conventional analgesics in the acute postoperative setting. OBJECTIVES: To evaluate the efficacy and safety of perioperative intravenous ketamine in adult patients when used for the treatment or prevention of acute pain following general anaesthesia. SEARCH METHODS: We searched CENTRAL, MEDLINE and Embase to July 2018 and three trials registers (metaRegister of controlled trials, ClinicalTrials...
December 20, 2018: Cochrane Database of Systematic Reviews
J C Galán Gutiérrez, B Tobera Noval, F J Sáenz Abós, M González Rodríguez, L A Fernández Meré, L A Sopena Zubiria
The addition of ultrasound to locoregional anaesthesia in the last few years has led to the description of various fascial thoracic blocks with analgesic purposes: PECS 1 and 2 block, serratus plane block, serratus intercostal fascial block, blockade in the plane of the thoracic transverse muscle..., which have been added to other well-known nerve blocks, such as thoracic paravertebral block or intercostal block. In this sense, locoregional anaesthesia has been universally recommended in patients with severe respiratory processes in order to avoid ventilatory support and subsequent weaning that considerably increases postoperative morbidity and mortality rates...
March 2019: Revista Española de Anestesiología y Reanimación
Poupak Rahimzadeh, Farnad Imani, Seyed Hamid Reza Faiz, Banafsheh Valiyan Boroujeni
Objective: A variety of methods, including neuraxial and regional blocks, have been used to manage post-mastectomy pain. This study evaluates the effect of serratus anterior plane block on acute pain after mastectomy. Methods: A total of 60 patients who were candidates for mastectomy under general anaesthesia were divided in this trial into two groups. After entering the recovery room, the first-experimental-group (SAB) underwent the ultrasound-guided serratus anterior block, but the second-control-group (CTL) received no block intervention...
September 2018: Turkish Journal of Anaesthesiology and Reanimation
R Sanllorente-Sebastián, J M de Vicente-Lorenzo, F J Mediavilla-Herrera, S Gutiérrez-García, I S Alario-Poza, Z Bustinza-Beaskoetxea
Breast cancer surgery can benefit from regional anaesthesia techniques, which can be used as a sole anaesthetic procedure in some cases where risk for general anaesthesia is high. Regional anaesthesia allows early recovery, reduces postoperative opioid and non opioid analgesics consumption and helps early home discharge, reducing thus costs. We present a case of an 87-year-old woman with multiple comorbidities who underwent breast cancer surgery. The patient was successfully surgically treated under serratus intercostal plane block anaesthesia...
January 2019: Revista Española de Anestesiología y Reanimación
Yemi Raheem Raji, Samuel Oluwole Ajayi, Adeyinka F Ademola, Taiwo Akeem Lawal, Omobolaji O Ayandipo, Tinuola Adigun, Babatunde Salako
Background: Acute kidney injury (AKI) is an underreported but major cause of morbidity and mortality among patients undergoing major surgical interventions in sub-Saharan Africa (SSA). Whereas AKI is often seen following major cardiac surgery in high-income countries, a similar spectrum of surgical diseases and interventions is not seen in developing countries. The impacts on surgical outcomes have also not been well characterized in SSA. This study aimed at identifying risk factors, incidence and determinants and short-term outcomes of AKI among patients undergoing major surgery...
August 2018: Clinical Kidney Journal
Surabhi Priya, Charu Bamba
Background: General anesthesia (GA) has been considered as the gold standard for breast cancer surgery. The problem of postoperative pain as well as the high incidence of nausea and vomiting has led to the search for a better modality for pain management with fewer side effects. In the last few years, paravertebral block (PVB) has gained immense popularity either in combination with GA or by itself for the anesthetic management of patients undergoing breast surgery. Context: Paravertebral block in breast surgery...
April 2018: Anesthesia, Essays and Researches
Satish Kumar, Deepali Goel, Santosh Kumar Sharma, Shahbaz Ahmad, Priyanka Dwivedi, Narendra Deo, Raka Rani
Background and Aims: Breast cancer has become the most common cancer in women worldwide. Acute post-operative pain following mastectomy remains a challenge for the anaesthesiologist despite a range of treatment options available. The present study aimed to compare the post-operative analgesic efficacy of pectoral nerve (Pecs) block performed under ultrasound with our standard practice of opioids and non-steroidal anti-inflammatory drugs for mastectomy. Methods: This randomised controlled study was conducted at a tertiary care teaching hospital in India, after obtaining ethical clearance...
June 2018: Indian Journal of Anaesthesia
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