Awake mastectomy under ultrasound guided thoracic paravertebral block in elderly patients

Santonastaso, Domenico Pietro; Chiara, Annabella de; Piccioni, Federico; Tognú, Andrea; Agnoletti, Vanni

doi:10.1016/j.jclinane.2018.03.014

Cited by 13 publications

(12 citation statements)

References 4 publications

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“…Deep levels of sedation were targeted (BIS 50–70) and respiratory depression was observed in some patients, including one patient who required airway instrumentation. In contrast to these studies, and similar to our previous experience,29 all our patients received double-level TPVB with a total dosage of 12 mL Ropivacaine 0.7%, no intra-operative opioid infusion and only propofol sedation with BIS between 75 and 90.…”

Section: Discussionmentioning

confidence: 57%

<p>Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study</p>

Santonastaso¹,

Chiara²,

Russo³

et al. 2019

JPR

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BackgroundGeneral anesthesia (GA) is the most commonly used anesthesiological technique for radical mastectomy operations and can be associated with loco-regional anesthesia techniques. The aim of our study, carried out on 51 patients, was to assess the effectiveness of thoracic paravertebral block (TPVB) associated with GA, or as a sole anesthesiological technique for postoperative pain control and for the reduction of intra and postoperative opioids consumption.Materials and methodsFifty-one patients with neoplastic breast disease and elected as candidates for radical mastectomy were included in the study. The primary outcomes for this study were intra and postoperative opioid consumption and postoperative pain intensity. In 37 patients, TPVB was associated with GA while in 14 patients it was used as the sole anesthesiological technique. Data are reported as mean with standard deviation median with interquartile range, number, and percentage, depending on the underlying distribution.ResultsWe did not use intra or postoperative opioids for any patient and the Numeric Rate Scale, assessed at time 0, at the end of the surgery, and 2, 6, 12, and 24 hrs after surgery, was >3 in seven patients only.ConclusionsThis study aims to show how TPVB can be used to carry out radical mastectomy procedures so that intra and postoperative opioids use can be avoided. In our study, TPVB was used in total mastectomy procedures in association with GA or as the sole anesthesiological technique, without the intra and postoperative use of opioids and with a significant reduction of local anesthetic dosages compared to those reported in the existing literature.

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Section: Discussionmentioning

confidence: 57%

<p>Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study</p>

Santonastaso¹,

Chiara²,

Russo³

et al. 2019

JPR

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“…So, a single dose of local anesthetic can receive multiple segments of anesthesia [24] [25] . TPVB has been studied as a possible alternative to provide high quality analgesia and great advantages in breast surgery, thoracic and upper abdominal surgery, thoracic myofascial pain syndrome, pain caused by cervical spondylosis, zoster-associated pain, etc [7][8][9][10]. Meanwhile, perioperative pain of PKP is also dominated by these nerves passing through the thoracic paravertebral space.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracic paravertebral block (TPVB) has been studied as a possible alternative to provide high quality analgesia and great advantages for many types of surgery [7][8][9][10]. Meanwhile, perioperative pain of PKP is also dominated by these nerves passing through the thoracic paravertebral space.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided thoracic paravertebral block for percutaneous kyphoplasty: A prospective non-randomized comparative study

Tang

Xia

TANG

et al. 2020

Preprint

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Introduction Kyphoplasty for osteoporotic vertebral compression fractures was short but painful. The purpose of the current study was to investigate the effects and safety of ultrasound-guided thoracic paravertebral block in patients undergoing percutaneous kyphoplasty (PKP). Methods A prospective study of 195 patients with thoracic compression fracture undergoing PKP was conducted. The patients were non-randomly assigned to receive an ultrasound-guided thoracic paravertebral block (Group P, n=96) and local infiltration anesthesia (Group L, n=99), and were compared along with intraoperative parameters and anesthetic effects. Visual analog scale (VAS) of pain, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured at pre-anesthesia (T0), post-anesthesia (T1), trocar insertion (T2), balloon dilatation (T3), cement injection (T4) and post-operation (T5). Results The anesthesia time was significantly longer in group P than in group L. There were no significant differences in the epidemiological data, operation time, blood loss, hospitalization time complications and costs between the two groups. The additional analgesics rate was significantly lower in group P than in group L. The investigators’ satisfaction scores, patients’ anesthesia satisfaction scores and intention rate of re-administration anesthesia were significantly higher in group P than in group L. Intraoperative VAS score (T1-T4) was significantly lower in group P than in group L. There was no significant difference in VAS scores (T0 and T5), SBP, DBP and HR between these two groups. Conclusion Ultrasound - guided thoracic paravertebral block achieved more effective analgesia in comparison to local infiltration groups in patients undergoing percutaneous kyphoplasty.

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“…[3][4][5][6][7] The use of locoregional anaesthesia techniques, thoracic paravertebral block (TPVB), pectoral nerve block (PECS), erector spinae plane (ESP) block, and serratus anterior plane (SAP) block in breast surgery has become widespread and many studies have shown that the use of these techniques enables excellent intraoperative and postoperative pain management with reduced opioid consumption. [8][9][10] The decision to use TPVB as a regional anaesthesia technique in breast surgery stems from our experience in performing this type of block, 11,12 supported by extensive existing literature that confirms that the use of TPVB in breast surgery provides satisfactory intraoperative and postoperative analgesia, without the need for opioids. 13,14 The use of ultrasound guidance ensures greater safety in the execution of the block, with reduced complications 15 and local anaesthetic dosage, insofar as anaesthetic diffusion is evaluated in real time.…”

Section: Introductionmentioning

confidence: 90%

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

Santonastaso

Chiara

Russo

et al. 2020

Tumori

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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.

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Awake mastectomy under ultrasound guided thoracic paravertebral block in elderly patients

Cited by 13 publications

References 4 publications

<p>Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study</p>

<p>Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study</p>

Ultrasound-guided thoracic paravertebral block for percutaneous kyphoplasty: A prospective non-randomized comparative study

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

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