Background:Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries.Materials and Methods:Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary dissection. They were randomly divided into two groups. The thoracic spinal group (S) (n = 20) underwent segmental thoracic spinal anesthesia with bupivacaine and fentanyl at T5-T6 interspace, while the other group (n = 20) underwent general anesthesia (G). Intraoperative hemodynamic parameters, intraoperative complications, postoperative discharge time from post-anesthesia care unit (PACU), postoperative pain and analgesic consumption, postoperative adverse effects, and patient satisfaction with the anesthetic techniques were recorded.Results:Intraoperative hypertension (20%) was more frequent in group (G), while hypotension and bradycardia (15%) were more frequent in the segmental thoracic spinal (S) group. Postoperative nausea (30%) and vomiting (40%) during PACU stay were more frequent in the (G) group. Postoperative discharge time from PACU was shorter in the (S) group (124 ± 38 min) than in the (G) group (212 ± 46 min). The quality of postoperative analgesia and analgesic consumption was better in the (S) group. Patient satisfaction was similar in both groups.Conclusions:Segmental thoracic spinal anesthesia has some advantages when compared with general anesthesia and can be considered as a sole anesthetic in breast cancer surgery with axillary lymph node clearance.

Background: This study was purposed to compare in vitro the volumetric accuracy of a newly introduced automatic infusion controller, AutoClamp with that of other commonly used infusion devices. Methods: In this prospective, randomized, controlled trial, 124 ASA I-II, female patients, aged 30-50 years, undergoing conservative breast cancer surgery were randomly assigned to one of four equal groups receiving either standard general anesthesia and two doses of hydrocortisone (Group GH, n=31), thoracic paravertebral block and two doses of hydrocortisone (Group PH, n=31), standard general anesthesia with no hydrocortisone (Group G, n=31), or thoracic paravertebral block with no hydrocortisone (Group P, n=31). IL-6 was measured at three time points: before operation, 6 and 12 hours postoperatively. CRP and cortisol were measured preoperatively and 6 hours postoperatively. Results: On comparing group PH and GH, there was significant decrease in IL-6 level in group PH compared to group GH at 6 hour (122.1±21.2 vs 135.8±29.8pg/dl), but insignificant difference at 24 hours (107.9±21.6 vs 106.8±15.9pg/dl). CRP showed significant decrease in the postoperative reading in group PH compared to group GH (1.63±0.32 vs 1.91±0.43mg/l), and also group PH showed significant decrease compared to the control group P (1.63±0.32 vs 2.2±0.54). Conclusion: addition of hydrocortisone to general anesthesia or thoracic paravertebral block attenuated production of IL-6 and CRP levels significantly postoperatively compared to either anesthetic regimen alone, but not the serum cortisol level, highlighting its role in modifying the stress response to surgery. However, the effect was more pronounced when combined with thoracic paravertebral block.