Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia

Author(s):Show less -

Matsumoto, Marcio ^{[1, 2]} ; Flores, Eva M. ^{[1, 2]} ; Kimachi, Pedro P. ^{[1, 2]} ; Gouveia, Flavia V. ^[1] ; Kuroki, Mayra A. ^[1] ; Barros, Alfredo C. S. D. ^[1] ; Sampaio, Marcelo M. C. ^[1] ; Andrade, Felipe E. M. ^[1] ; Valverde, Joao ^{[1, 2]} ; Abrantes, Eduardo F. ^[1] ; Simoes, Claudia M. ^{[1, 2]} ; Pagano, Rosana L. ^[1] ; Martinez, Raquel C. R. ^[1]

Affiliation

^[1] Hosp Sirio Libanes, Rua Prof Daher Cutait 69, BR-01308060 Sao Paulo - Brazil

^[2] Sao Paulo Serv Med Anestesia, Rua Adma Jafet, 91 Bela Vista, BR-01308050 Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: SCIENTIFIC REPORTS; v. 8, MAY 18 2018.
• Web of Science Citations: 4

Abstract

Surgery is the first-line treatment for early, localized, or operable breast cancer. Regional anesthesia during mastectomy may offer the prevention of postoperative pain. One potential protocol is the combination of serratus anterior plane block (SAM block) with pectoral nerve block I (PECS I), but the results and potential benefits are limited. Our study compared general anesthesia with or without SAM block + PECS I during radical mastectomy with axillary node dissection and breast reconstruction using evaluations of pain, opioid consumption, side effects and serum levels of interleukin (IL)-1beta, IL-6 and IL-10. This is a prospective, randomized controlled trial. Fifty patients were randomized to general anesthesia only or general anesthesia associated with SAM block + PECS I (25 per group). The association of SAM block + PECS I with general anesthesia reduced intraoperative fentanyl consumption, morphine use and visual analog pain scale scores in the post-anesthetic care unit (PACU) and at 24 h after surgery. In addition, the anesthetic protocol decreased side effects and sedation 24 h after surgery compared to patients who underwent general anesthesia only. IL-6 levels increased after the surgery compared to baseline levels in both groups, and no differences in IL-10 and IL-1 beta levels were observed. Our protocol improved the outcomes of mastectomy, which highlight the importance of improving mastectomy protocols and focusing on the benefits of regional anesthesia. (AU)

• FAPESP's process: 15/26079-8 - Participation of descending serotonergic analgesia pathway and changes in inflammatory and neurodegenerative response in the treatment of neuropathic pain by transcranial direct-current stimulation
• Grantee: Rosana de Lima Pagano
• Support type: Regular Research Grants
• FAPESP's process: 11/08575-7 - The role of dopaminergic modulation in the lateral nucleus of amygdala during active avoidance response
• Grantee: Raquel Chacon Ruiz Martinez
• Support type: Research Grants - Young Investigators Grants
• FAPESP's process: 13/20602-5 - Prospective analyses of the functional results of philanthropist bilateral amygdalectomy in patients with refractory aggression
• Grantee: Flavia Venetucci Gouveia
• Support type: Scholarships in Brazil - Doctorate