Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction

Johnson, Aaron N.; Colakoğlu, Salih; Reddy, A Swetha; Kerwin, Clara M.; Flores, Roland; Iorio, Matthew L.; Mathes, David W.

doi:10.5812/aapm.105686

Cited by 16 publications

(12 citation statements)

References 60 publications

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“…Breast cancer remains the leading cause of death in women, and surgical treatment often provides the best prognosis. Even despite surgical removal, tumor recurrence and distant metastasis still pose a major challenge (40,41). It is known that the risk of metastasis is both dependent on the metastatic potential of the tumor and the ability of the host immune response to fight it off (42).…”

Section: Clinical Studiesmentioning

confidence: 99%

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

et al. 2022

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: The potential for cancer cells to grow and to metastasize depends on complex interactions between inflammatory signals and pathways, immune cells, and elements of the stromal tissue in which they invade. Related to the nature of many cancers, the probability of recurrence can potentially be quite high for some patients. Immunology, lifestyle modifications, timing of disease, genetics, age, gender, and race are only a handful of ways the likelihood of cancer recurrence can be influenced. The quantity, or density, of certain immunological cells or factors, plays a role in the propagation of cancer cells. Opioids are often used in cancer patients for acute postoperative and chronic pain management. While they can produce significant pain relief, the type of analgesic utilized is important, as it may influence cancer propagation. In this regard, certain opioids have been found to increase T regulatory cells while suppressing NK cell function. Morphine may promote tumor neovascularization and expansion. Fentanyl administration significantly diminishes NK-cells and CD8+ cytotoxic T-cells. In a recent meta-analysis, propofol-based anesthesia improved both cancer-free survival and overall survival. COX inhibitors have also shown promise in persevering cancer immune function, as in literature involving ketorolac and celecoxib. In summary, inhaled anesthesia and opioids may contribute to a pro-tumor metastasis environment also known as cancer propagation; whereas propofol and COX inhibitors may provide a better alternative to reduce cancer recurrence and propagation.

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Section: Clinical Studiesmentioning

confidence: 99%

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

et al. 2022

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“…There has been a remarkable resurgence of regional anesthesia, especially peripheral nerve blocks (PNB), with widespread implementation of these in enhanced recovery pathways after surgery and pain management (1,2). Although, opioids are the cornerstone analgesics for perioperative pain relief, regional anesthesia has ameliorated postoperative pain, decreased opioid consumptions, and their potential complications (3)(4)(5)(6)(7)(8). Furthermore, some peripheral nerve entrapments and surgical conditions can be successfully treated by peripheral nerve blocks (9)(10)(11)(12).…”

Section: Contextmentioning

confidence: 99%

Supraclavicular vs. Infraclavicular Brachial Plexus Nerve Blocks: Clinical, Pharmacological, and Anatomical Considerations

et al. 2021

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: Peripheral nerve blocks (PNB) have become standard of care for enhanced recovery pathways after surgery. For brachial plexus delivery of anesthesia, both supraclavicular (SC) and infraclavicular (IC) approaches have been shown to require less supplemental anesthesia, are performed more rapidly, have quicker onset time, and have lower rates of complications than other approaches (axillary, interscalene, etc.). Ultrasound-guidance is commonly utilized to improve outcomes, limit the need for deep sedation or general anesthesia, and reduce procedural complications. Given the SC and IC approaches are the most common approaches for brachial plexus blocks, the differences between the two have been critically evaluated in the present manuscript. Various studies have demonstrated slight favorability towards the IC approach from the standpoint of complications and safety. Two prospective RCTs found a higher incidence of complications in the SC approach – particularly Horner syndrome. The IC method appears to support a greater block distribution as well. Overall, both SC and IC brachial plexus nerve block approaches are the most effective and safe approaches, particularly under ultrasound-guidance. Given the success of the supraclavicular and infraclavicular blocks, these techniques are an important skill set for the anesthesiologist for intraoperative anesthesia and postoperative analgesia.

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“…Although opioids are the most common pain killers used to control pain after surgery, there is always concern about their risk, such as dependence and complications (5,6). Epidural and paravertebral blocks for peri-operative pain management for thoracic and abdominal surgeries are commonly used regional anesthetic techniques (7)(8)(9). To provide a longer duration of analgesia, a number of adjuvants, such as opi-oids, non-steroidal anti-inflammatory drugs, and alpha 2agonists have been used in conjunction with local anesthetics for peripheral and neuraxial blocks, including paravertebral blockade (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Adding Dexmedetomidine to Bupivacaine in Ultrasound-guided Thoracic Paravertebral Block for Pain Management after Upper Abdominal Surgery: A Double-blind Randomized Controlled Trial

et al. 2021

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Background: Paravertebral blocks are one of the possible postoperative pain management modalities after laparotomy. Adjuvants to local anesthetics, including alpha agonists, have been shown to lead to better pain relief and increased duration of analgesia. Objectives: The aim of this study is to examine the effect of adding dexmedetomidine to bupivacaine for ultrasound-guided paravertebral blocks in laparotomy. Methods: In this double-blind, randomized controlled trial (RCT), we enrolled 42 patients scheduled for T6 to T8 thoracic paravertebral block (TPVB) for analgesia after laparotomy. The patients were randomly assigned into two groups of BD (bupivacaine 2.5 mg/mL 20 mL plus dexmedetomidine 100 µg) and B (bupivacaine 20 mL alone). Following surgery, intravenous fentanyl patient-controlled analgesia was initiated. The numerical rating scale (NRS) for pain, sedation score, total analgesic consumption, time to first analgesic requirement, side effects (such as nausea and vomiting), respiratory depression, and patients’ satisfaction during the first 48 hours of evaluation were compared in the two groups. Results: Pain scores and mean total analgesic consumption at the first 48 hours in the BD group were significantly lower than Group B (P = 0.03 and P < 0.001, respectively). The time of first analgesic request was significantly longer in BD group (P < 0.001). Sedation scores and side effects did not differ significantly between the two groups. Conclusions: Adding dexmedetomidine to bupivacaine for TPVB after laparotomy yielded better postoperative pain management without significant complications.

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Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction

Cited by 16 publications

References 60 publications

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence

Supraclavicular vs. Infraclavicular Brachial Plexus Nerve Blocks: Clinical, Pharmacological, and Anatomical Considerations

Adding Dexmedetomidine to Bupivacaine in Ultrasound-guided Thoracic Paravertebral Block for Pain Management after Upper Abdominal Surgery: A Double-blind Randomized Controlled Trial

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