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 técni… Show more
“…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.…”
ObjectivesThe contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery.MethodsPatients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121) or fentanyl with sevoflurane general anesthesia (GA group, n = 126). Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests.ResultsPatients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours), less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,), less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5]), but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg). Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions.ConclusionsThe combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery.Trial RegistrationClinicalTrial.gov NCT00418457
“…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.…”
ObjectivesThe contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery.MethodsPatients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121) or fentanyl with sevoflurane general anesthesia (GA group, n = 126). Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests.ResultsPatients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours), less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,), less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5]), but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg). Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions.ConclusionsThe combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery.Trial RegistrationClinicalTrial.gov NCT00418457
“…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.…”
Background:Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries.Materials and Methods:Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary dissection. They were randomly divided into two groups. The thoracic spinal group (S) (n = 20) underwent segmental thoracic spinal anesthesia with bupivacaine and fentanyl at T5-T6 interspace, while the other group (n = 20) underwent general anesthesia (G). Intraoperative hemodynamic parameters, intraoperative complications, postoperative discharge time from post-anesthesia care unit (PACU), postoperative pain and analgesic consumption, postoperative adverse effects, and patient satisfaction with the anesthetic techniques were recorded.Results:Intraoperative hypertension (20%) was more frequent in group (G), while hypotension and bradycardia (15%) were more frequent in the segmental thoracic spinal (S) group. Postoperative nausea (30%) and vomiting (40%) during PACU stay were more frequent in the (G) group. Postoperative discharge time from PACU was shorter in the (S) group (124 ± 38 min) than in the (G) group (212 ± 46 min). The quality of postoperative analgesia and analgesic consumption was better in the (S) group. Patient satisfaction was similar in both groups.Conclusions:Segmental thoracic spinal anesthesia has some advantages when compared with general anesthesia and can be considered as a sole anesthetic in breast cancer surgery with axillary lymph node clearance.
“…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.…”
Section: Discussionmentioning
confidence: 90%
“…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.…”
Section: Discussionmentioning
confidence: 95%
“…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.…”
Background: Thoracic epidural anaesthesia (TEA) has many benefits over general anaesthesia in major abdominal surgeries including avoidance of endotracheal intubation. Aims: To evaluate the feasibility of TEA for major abdominal surgeries in the private hospital setting. Patients and methods: This was a retrospective study of all major abdominal surgeries performed under TEA in two private hospitals in Uyo, Akwa Ibom State, Nigeria over a two-year period. All thoracic epidural anaesthesia was performed under aseptic conditions at the T 8/9 , T 9/10 , or T 10/11 interspinous space using a size 18G Tuohy epidural needle and catheter inserted as appropriate. A test dose of 3 ml of 1% lidocaine with adrenaline was used in all patients, after which a loading dose of 10-15 ml of 2% lidocaine with adrenaline was injected at 5 ml every 5 minutes till a block height of approximately T 4-L 1 was obtained. Anaesthesia was maintained with 5 ml of 2% lidocaine with adrenaline every 45 minutes till the end of surgery. The operative condition was assessed on the basis of sedation and analgesic requirement, as well as response to mesenteric traction. The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Data were obtained from the patients' folders and operation register. Information obtained included: age, gender, ASA status, diagnosis and type of surgery performed. Data analysis was performed using SPSS®, version 16. Results: Twelve patients underwent major abdominal surgeries under TEA. The mean age (range) was 49.58 (20-78) years, with a male to female ratio of 1:1.4. TEA was adequate in 10 (83.3%) patients, while two (16.7%) patients developed total spinal anaesthesia and were successfully resuscitated and their surgeries completed under general endotracheal anaesthesia. Conclusion: TEA for major abdominal surgeries is feasible. However, careful patient selection, a meticulous approach and preparation for resuscitation is required to prevent and manage complications.
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