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

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusions: Quadrantectomy with exclusively regional anaesthesia and thoracic paravertebral block can be performed with the patient awake and collaborating.

Efficacy of erector spinae plane block versus thoracic paravertebral block for postoperative analgesia in modified radical mastectomy: a randomized controlled trial

“…In our hospital the TPV block has been performed for many years for both mastectomies and quadrantectomies, therefore, its effectiveness has been extensively con rmed even for interventions with awake patients [7,21,34].…”

Why do Older Women with Invasive Breast Cancer Avoid Surgery? A Qualitative Analysis of Factors Influencing the Decision of Patients and Physicians

“…This study reported no morbidity in the form of hematoma, wound infection or skin ap necrosis. A prospective observational series of patients undergoing breast conserving surgery under a paravertebral block and mild sedation reported successful outcomes, including no need for intraoperative or postoperative opioids [27]. A survey of breast surgeons noted that approximately two thirds of respondents considered breast surgery under local anesthesia to be well-tolerated amongst older women [28].…”

Pathophysiological Advantages of Spontaneous Ventilation

“…However, another study demonstrated no significant difference in disease recurrence and survival between the sOLV and mOLV methods ( 34 ). Meanwhile, a study on awake breast cancer surgery suggested that both extrathoracic cancer cases and lung cancer sOLV cases had shorter operative time and length of hospital stay ( 35 , 36 ). Additionally, a case series presented about successful esophagectomy wherein the thoracic part was performed under spontaneous ventilation ( 37 ).…”