Cervical Epidural Anaesthesia with Ropivacaine for Modified Radical Mastectomy

Abstract

BackgroudCervical epidural anaesthesia (CEA) using local anesthetics (LA) is a well established technique for the surgeries in the neck, chest and upper arms. Recently ropivacaine is introduced with better safety profile. ObjectivesThe aim was to observe the safety of Cervical epidural anaesthesia as an anaesthetic technique and to compare the efficacy of epidural 0.25% bupivacaine with 0.375% ropivacaine for radical mastectomies. MethodsA double blind study was conducted on 40 ASA grade I / II females who received CEA with 10 ml of 0.25% of bupivacaine +25µg of fentanyl in group B (n=20) and 10 ml of 0.375% of ropivacaine +25µg of fentanyl in group R (n=20) epidurally. Assessment of the block, vital monitoring and complications noted. ResultsNo significant differences observed in the onset of sensory block (5.05min and 5.4min in group B and R respectively, P>0.05).The mean motor blockade score, time to achieve complete blockade and time to grade I motor recovery was significantly longer in group B (2.3, 22.5 and 79.5 minutes respectively) as compared to group R (1.5, 18.3 and 66.3 minutes respectively, P<0.05). Respiratory distress developed in two patients of group B that required general anaesthesia (GA) with intubation. ConclusionUse of 0.37% ropivacaine is safer than 0.25% bupivacaine for CEA for radical mastectomy. It provides good surgical anaesthesia with lesser degree of motor blockade and the respiratory effects.

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

“…A cervical epidural local anesthetic (with or without an opioid) infusion may also be used to provide intraoperative anesthesia and postoperative analgesia for major breast surgery [139][140][141][142][143]. The selection of a cervical level catheter insertion-usually between the C7 and T1 vertebrae-is based on the fact that the pectoralis muscle is innervated from the brachial plexus (C5-C8) [144], and was encouraged by a prior report that a cervical epidural block provides better sensory block for thoracic procedures than a high thoracic epidural block [145].…”

A Prospective Observational Study to Assess the Efficacy of Thoracic Epidural Anaesthesia for Mastectomy

“…Various forms of regional anaesthesia have been tried instead of conventional general anaesthesia for breast surgeries. [1][2][3][4][5] Thoracic epidural anaesthesia has been found effective in various studies. [6][7][8][9][10] Balzarena et al found its advantages over general anaesthesia with greater satisfaction and earlier discharge, [6] Clinical benefits associated with epidural anaesthesia and analgesia is achieved with the thoracic approach, particularly with the appropriate use of local anaesthetics.…”

“…Various regional techniques like local infiltration, intercostal block, paravertebral block, brachial plexus block, spinal anaesthesia, cervical epidural and thoracic epidural have been tried. [1][2][3][4][5] We selected thoracic epidural based on clinical evidence from various studies of the effectiveness of it and the lower incidence of complications. [6][7][8][9][10] This familiar technique is associated with lower incidence and severity of perioperative physiologic disruptions.…”

The Management of Anesthesia for Breast Surgery in a Progressive Supranuclear Palsy Case

“…3,4 The advantages of epidural anesthesia are higher quality of postoperative control, less nausea and vomiting, short recovery period after surgery and short hospital stay. 5 On the other hand, high thoracic epidural anesthesia and cervical epidural anesthesia have some negative effects on heart and respiratory functions.…”

“…3,4 Because the anterior thoracic wall is not innervated only by thoracic nerves; combining interscalene block to thoracic epidural block should be preferred.…”