Estudo comparativo entre anestesia peridural torácica e anestesia geral em mastectomia oncológica

Abstract

Rev Bras AnestesiolARTIGO CIENTÍFICO 2008; 58: 6: 561-568 SCIENTIFIC ARTICLE RESUMO Belzarena SD -Estudo Comparativo entre Anestesia Peridural Torácica e Anestesia Geral em Mastectomia Oncológica. JUSTIFICATIVA E OBJETIVOS:A anestesia peridural torácica é utilizada com freqüência para procedimentos estéticos da mama e há poucos relatos de seu emprego para mastectomias com exploração axilar. O presente estudo comparou a técnica com anestesia geral em operações oncológicas da mama. MÉTODO: CONCLUSÕES:A técnica peridural tem algumas vantagens com relação à anestesia geral e pode ser considerada uma opção para anestesia em mastectomias oncológicas com esvaziamento axilar.Unitermos: ANESTESIA: Regional, peridural; CIRURGIA: Oncológica, mastectomia. SUMMARY Belzarena SD -Comparative Study between Thoracic EpiduralBlock and General Anesthesia for Oncologic Mastectomy. BACKGROUND AND OBJECTIVES:Thoracic epidural block is frequently used for esthetic breast surgeries but reports of its use in mastectomies with axillary exploration are very rare. The present study compared this technique with general anesthesia in oncologic surgeries of the breasts. METHODS:Forty patients were divided in two groups. The epidural group (n = 20) underwent epidural thoracic block with bupivacaine and fentanyl associated with sedation with midazolam. The other group (n = 20) underwent conventional general anesthesia with propofol, atracurium, and fentanyl, and maintenance with O 2 and isoflurane. Duration of the surgery, the need for intraoperative complementation of anesthesia or sedation, and intraoperative hemodynamic parameters were recorded. In the postoperative period, length of time until discharge from the recovery room and from the hospital, severity of pain, analgesic consumption, adverse effects, and satisfaction with the anesthetic techniques were recorded. RESULTS:Both groups were similar and differences in the duration of the surgery were not observed. Complementary sedation was necessary in 100% of the patients who underwent epidural block and complementary sedation with infiltration of local anesthetic in the axilla in 15% of the patients in this group. The rate of hypertension was more frequent in the group of patients who underwent general anesthesia, while hypotension was more frequent in the epidural group. Pruritus was observed in 55% of the patients in the epidural group. Nausea (30%) and vomiting (45%) were more frequent in the general anesthesia group. The quality of postoperative analgesia was better in the epidural group, which also presented lower consumption of analgesics; the length hospitalization in this group was also lower. CONCLUSIONS:Epidural block has some advantages when compared with general anesthesia and can be considered an anesthesia option in oncologic mastectomies with axillary lymph node dissection.

Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

“…The combination of regional anesthesia and general anesthesia may result in significant hemodynamic fluctuations [ 34 ], potentially causing serious adverse events such as asystole [ 35 ]. The TPVB can be thought of as a unilateral thoracic epidural block, and there are few if any clinically significant hemodynamic effects in patients following mastectomy.…”

Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery

“…Nowadays, surgical intervention is more conservative, but in most cases, partial or total mastectomy associated with axillary exploration to remove lymph nodes for staging or immune-chemical testing is still necessary. [1] General anesthesia is currently the standard technique used for surgical treatment of breast cancer. The drawbacks of general anesthesia include, but not limited to, inadequate pain control due to a lack of residual analgesia, high incidence of nausea and vomiting, and increasing the length of hospitalization.…”

Thoracic epidural anaesthesia for major abdominal surgeries: experience in private hospital setting in Uyo, South-South Nigeria

“…Bhosle et al 5 documented hypotension warranting the use of vasopressors in 23.33% of their patients; no shivering, nausea or vomiting was recorded. In contrast, Balzarena et al 11 reported a high incidence of hypotension (60%) in 20 patients who required TEA for mastectomy; also, pruritus and vomiting were recorded postoperatively. This difference may be due to differences in the epidural drug dosing and blood loss during the procedure.…”

“…This high success rate is comparable to previous studies, which reported 100% success in their series. 5,11 In this study, TEA was applied to a variety of surgical procedures with specific anaesthetic considerations including laparotomy for intestinal obstruction and nephrectomy, thus demonstrating the versatility of epidural anaesthesia. Similarly, Bhosle et al 5 in a previous retrospective study demonstrated the feasibility and safety of TEA in a variety of upper and lower abdominal surgeries including emergency procedures.…”

“…Previous studies in a larger population have shown that TEA is safe. 5,11 This complication may be attributed to inappropriate patient selection and technical problems and not the technique per se. The first patient was a 75-year-old woman in whom localisation of the epidural space was difficult; five attempts were made.…”