Paravertebral anaesthesia with or without sedation versus general anaesthesia for women undergoing breast cancer surgery

Chhabra, Anjolie; Prabhakar, Hemanshu; Subramaniam, Rajeshwari; Arora, Manali; Srivastava, Anurag; Kalaivani, Mani

doi:10.1002/14651858.cd012968

Cited by 8 publications

(6 citation statements)

References 47 publications

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“…Abdallah FW et al [19] suggested that multilayer ultrasound-guided paravertebral block combined with intravenous general anaesthesia can provide a reliable anaesthetic effect, improve postoperative analgesia, accelerate postoperative recovery, and enable patients to be discharged as soon as possible compared with inhaled gas general anaesthesia and opioid general anaesthesia. AB et al [20]suggested that paravertebral anaesthesia may also reduce the use of postoperative analgesia as well as rest and exercise pain at 6 and 24 hours after surgery while reducing the occurrence of postoperative nausea and vomiting. These anaesthesia methods will be gradually employed in the future to improve patients' postoperative satisfaction and accelerate their recovery.…”

Section: Discussionmentioning

confidence: 99%

Application of radical mastectomy in ambulatory surgery centres under COVID-19

Zhou¹,

Xiao

Yang

et al. 2022

Preprint

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Background Breast cancer has surpassed lung cancer as the most common cancer. Day surgery for breast cancer has been widely carried out worldwide, but the development of day surgery in China is relatively slow. To reduce the spread of coronavirus 2019 (COVID-19), major surgery centres have optimized the management procedures of day surgery to different degrees. However, relevant research on whether the rapid turnover of day surgery and the excessive human resources placed in the prevention and control of the COVID-19 epidemic will affect the quality of day surgery is lacking. Method The demographic data, clinical data and postoperative complications of breast cancer patients in the single medical group of West China Hospital of Sichuan University from March 2020 to June 2021 were retrospectively collected, and the complications after discharge and the safety of day surgery were analysed. Results The average age significantly differed between the ward surgery group (WS) and the day surgery group (DS) (P = 0.030). Regarding postoperative complications, no significant differences were detected in total surgical complications (P = 0.676) or anaesthesia complications (P = 0.126) between the two groups. In the logistic analysis, day surgery was not a risk factor for postoperative complications during the COVID-19 pandemic (P = 0.676, OR = 1.154, 95% CI: 0.590–2.257). An increase in age significantly increased the incidence of postoperative surgical complications (P = 0.024, OR = 1.051, 95% CI: 1.007–1.097). At the same time, lymph node dissection after sentinel lymph node biopsy also led to an increase in the incidence of postoperative surgical complications (P = 0.030, OR = 3.372, 95% CI: 1.125–10.106). In the survival curve, no significant difference in DFS was detected between the two groups (P = 0.353). Conclusion Radical mastectomy at day surgery centres is safe and reliable under strict COVID-19 management guidelines.

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Section: Discussionmentioning

confidence: 99%

Application of radical mastectomy in ambulatory surgery centres under COVID-19

Zhou¹,

Xiao

Yang

et al. 2022

Preprint

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“…There have been a number of systematic reviews over the last few years which have not specifically mentioned tissue planes in the context of regional anaesthesia but which clearly relate to that concept [151][152][153][154][155][156][157][158][159][160][161][162][163][164]. These have all been procedure specific and, despite apparent clinical enthusiasm for the different techniques, are quite often neutral or negative in their recommendations.…”

Section: Systematic Reviewsmentioning

confidence: 99%

The Tissue Plane

Cornish¹

2022

Topics in Regional Anesthesia

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In recent times, terms such as ‘interfascial plane block’ and ‘fascial plane block’ have become common in describing regional anaesthesia blocks such as transversus abdominis plane (TAP), serratus anterior plane (SAP) and erector spinae plane (ESP). In fact, none of these names accurately describes the applied anatomy involved in each named technique, as the acronym is only one part of the anatomic jigsaw puzzle. The correct term is ‘tissue plane block’, which derives from surgical terminology. The tissue plane is not new to regional anaesthesia, as it has been the endpoint of ‘loss of resistance’ and ‘pop’ techniques for many decades. However, the game-changer is that now we can see the tissue plane courtesy of ultrasound. The purpose of this chapter is to review the history of the tissue plane in relation to its use in regional anaesthesia, and to see how ultrasound has further advanced the regional anaesthesiologist’s options in this regard. The chapter will also review how an understanding of tissue dynamics can further enhance our clinical results by manipulating the characteristics of the tissue plane.

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“…The technique has been associated with a low complication rate that includes vascular puncture (1.4%), pleural puncture (0.3%), transient Horner's syndrome (7.1%), and epidural block (0.7%) [20]. Despite the excellent safety profile and many advantages of this block, it is not commonly used for breast surgery because of the technical skills required.…”

Section: Disadvantagesmentioning

confidence: 99%

Regional Anaesthesia for Breast Surgery

2021

IJRA

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Innervation of the breast:nd thThe breast receives innervation mainly from the 2 to 6 thoracic (T2-6) spinal nerves. The thoracic spinal nerves after emerging from the intervertebral foramina divide into dorsal and ventral ramii [1]. The dorsal ramii provide innervation to the skin and the muscles of the medial back. Each ventral ramus continues anteriorly as an intercostal nerve, accompanied by an intercostal artery and vein lying between the innermost and the internal intercostal muscle along the inferior borders of the respective ribs.Near the midpoint of the hemithorax corresponding to the midaxillary line, each intercostal nerve gives a lateral cutaneous branch that further divides into an anterior and posterior branch. Sensory supply of lateral aspect of breast is provided by the anterior divisions of the lateral cutaneous branches of T2-T6 intercostal nerves with contributions from T1 and T7 nerves. The intercostal nerves interconnect providing overlapping nerve supply to the breast. The main intercostalnerve continues anteriorly and terminates as an anterior cutaneous branch that further divides into a medial and lateral divisions which provide cutaneous innervation over the sternum and medial part of the breast respectively [2-4] (Figure 1) [5].The intercostobrachial nerve (T2) mainly provides cutaneous innervation to the axillary tail of the breast, the axilla, and the medial upper arm. The medial cutaneous nerve of the arm (branch of the brachial plexus) may also supply the roof of the axilla and may receive contributions from T1 and T3 nerves. The supraclavicular nerves of the cervical plexus provide sensory supply to the infraclavicular or supramammary area [6, 7], (Figure 1). The muscles of chest wall underlying the breast, the pectoralis major (PMM) and pectoralis minor (PmM) are innervated by mixed motor and sensory nerves, the lateral pectoral nerves (LPN) (C5-7, lateral cord) and the medial pectoral nerves (MPN) (C7-T1, medial cord), branches of the brachial plexus. These nerves also possess proprioceptive and nociceptive fibres and thus traction, stretching or muscle spasm of these muscles can lead to dull, aching perioperative pain. In addition, the long thoracic nerve (LTN) (C5-7) and the thoracodorsal nerve (TDN) (C6-8, posterior cord) branches of the brachial plexus innervate the serratus anterior (SAM) and the latissimus dorsi (LD) muscles, that form part of the axilla [8]. Therefore, the breast, axilla and the surrounding tissues are supplied by interconnected network of T2-T6 intercostal nerves, branches of the brachial plexus and the lower branches of the cervical plexus (Figure 1) [5].Regional anaesthesia blocks used for Breast surgery: These blocks will be decribed starting from the older, posteriorly performed blocks to the newer, superficial antero-lateral chest wall blocks for breast surgery. Thoracic Epidural Anaesthesia (TEA)Thoracic epidural block performed at T4 has been used to provide segmental anaesthesia and analgesia extending from C8-T6 for breast surgery.Advantages of TE...

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Paravertebral anaesthesia with or without sedation versus general anaesthesia for women undergoing breast cancer surgery

Cited by 8 publications

References 47 publications

Application of radical mastectomy in ambulatory surgery centres under COVID-19

Application of radical mastectomy in ambulatory surgery centres under COVID-19

The Tissue Plane

Regional Anaesthesia for Breast Surgery

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