A Prospective Observational Study on the Effectiveness of Segmental Spinal Anesthesia in Patients Posted for Modified Radical Mastectomies

Abstract

Background: Modified radical mastectomy is a treatment of choice in patients having carcinoma breast. The higher chances of complications with general anesthesia lead to a change in our clinical practice towards regional anesthesia. The current literature revealed that the maximum distance between the dura mater and the spinal cord is at the mid-thoracic level, but very few studies are advocating for the use of segmental spinal anesthesia for modified radical mastectomies. Therefore, the present study is planned to assess the effectiveness of segmental spinal anesthesia in patients posted for modified radical mastectomies. Material and Methods:The present study was conducted at a tertiary care centre between April 2020 to November 2022 after approval by the institute's ethical and research committee. The study recruited 78 patients aged between 20-70 years with American Society of Anesthesiologists (ASA) physical status I-III who were scheduled for modified radical mastectomy with axillary dissection. A subarachnoid block was performed at T5-T6 or T6-T7 levels with 27 G Quincke Babcock needle using a midline approach with a 45° tilt of the needle in all the patients under aseptic precautions after. Once the free flow of Cerebrospinal fluid (CSF) was confirmed, 1.5 ml isobaric levobupivacaine with 5 mcg of Dexmedetomidine was administered. Results:In the present study, 97% of the surgeons were satisfied with the procedure. All the patients had stable hemodynamics and adequate sensory and motor blockade. A single episode of hypotension was noted in 9% percent of the patients and 6% of them had bradycardia once during the procedure. However, the alterations in hemodynamics were successfully managed during the procedure. Paresthesia was found during needle insertion in 4% of patients, but none of them had any neurological damage. Conclusion:Segmental spinal anesthesia is a safe alternative to general anesthesia in cases of carcinoma breast undergoing modified radical mastectomy.

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

“…Another possible mechanism is the presence of low CSF volume and thinner nerve route at the thoracic level and sparing of the lower extremities led to less vasodilatation in comparison to the block at the lumbar leve l2 . Fewer hemodynamic alterations were also reported in the other studies 2,13,14,23 .…”

“…van Zundert et al3 and Heisnam et al 21 also observed minimal side effects in segmental thoracic spinal anaesthesia for laparoscopic cholecystectomy. Paliwal et al 2 and Chandra et al 14 also reported fewer unwanted effects in thoracic segmental block for breast surgery. Paresthesia is not desired but can occur with any technique of spinal anaesthesia.…”

“…However, segmental spinal anesthesia in the thoracic level remains the most controversial technique amongst anesthesiologists due to the fear of spinal cord injury. Paliwal et al 2 Chandra et al 14 and Elakany 23 have provided some evidence that segmental spinal anaesthesia can be used for breast surgeries. This study reveals that thoracic spinal anaesthesia can be used to provide a segmental block sufficient enough to perform breast surgeries in ASA I and II patients.…”

“…Issues related to thoracic spinal anaesthesia includes neurological damage because of a puncture at a higher level, ventilation impairment due to the involvement of the diaphragm, and hemodynamic alterations due to the higher block. Many studies in the literature that showed that the accidental puncture of the dura, even at high thoracic space, does not lead to any neurological damage 14 . Lee et al measured medial sagittal slices of the thoracic and lumbar region with the help of magnetic resonance imaging in 19 patients.…”

“…Segmental spinal anesthesia involves the blockade of specific segments at the thoracic level. Furthermore, the anesthetic dose requirement during the procedure is lower, which minimally affects cardiovascular stability 14 . This technique can be valuable for providing greater hemodynamic stability, better analgesia, with higher patient satisfaction, lesser incidence of nausea, vomiting and reduced postanaesthesia care stay [3][4][5]12 .…”