Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery

Abstract

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.

Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases

“…Nevertheless, we were able to find in literature only one randomized study mentioning the use of STSA in surgical procedures involving the breast and the axillary region. 15 …”

“…Nevertheless, though three recent series from our Institution conducted on a large population of elderly patients already illustrated the feasibility, efficacy and safety of thoracic continuous spinal anesthesia (TCSA) in abdominal and urological surgery, 12–14 the secure and reliable use of STSA in patients undergoing major breast surgery and axillary lymph node dissection (ALND) was described only by Elakany et al 15 …”

Comparative study of mid-thoracic spinal versus epidural anesthesia for open nephrectomy in patients with obstructive/restrictive lung disease: A randomized controlled study

“…In contrast, Elakany et al . [ 16 ] proved that hypotension and bradycardia developed in 15% of cases that received segmental thoracic spinal anesthesia. However, our findings coincide with those of Imbelloni L E,[ 15 ] who used a similarly reduced dose of hyperbaric bupivacaine (7.5 mg) given in combination with fentanyl, and achieved less hemodynamic instability and fewer adverse events.…”

Comparison between bupivacaine and ropivacaine in thoracic epidural anaesthesia for modified radical mastectomy – A randomized controlled trial

“…3 Regional anesthesia provides effective anesthesia and analgesia in the perioperative period. Various regional anesthetic techniques have been used for breast surgeries, like local wound infiltration, cervical epidural, 4 thoracic epidural anesthesia, 5 thoracic paravertebral block, 6 thoracic spinal anesthesia, 7 interpleural block 8 etc.…”