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Dwivedi S, Arnav A, Agarwal VK, Deshpande SK, Sharma R, Saidha N. Predictors of Unilateral Arm Lymphedema in Non-obese Locoregionally Advanced Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy, Modified Radical Mastectomy, and Postoperative Irradiation. Eur J Breast Health 2024; 20:149-155. [PMID: 38571684 PMCID: PMC10985571 DOI: 10.4274/ejbh.galenos.2024.2024-1-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
Objective The most dreaded long-term complication of axillary lymph node dissection remains upper arm lymphedema. Our study has strategized the three most common identified causes of post treatment arm lymphedema, i.e., obesity, radiation, and neoadjuvant chemotherapy and tried to identify the histopathological and clinical or surgical factors which can predict arm lymphedema. Materials and Methods This is a prospective observational study was conducted at a tertiary care referral centre in India, with strict inclusion criteria of BMI <30 kg/m2, age <75 years, presence of metastatic axillary node proven by FNAC, received anthracycline based neoadjuvant chemotherapy and postoperative nodal irradiation, and completed 24 months of regular follow-up. Results Total of 70 patients were included in the study. The mean age of the patients was 50.3 years (±12.9). lymphovascular invasion, total number of lymph nodes removed from level III, total number of days drain was left in situ and maximum drain output were found to be significantly (p<0.05) associated with arm lymphedema. Conclusion In patients undergoing modified radical mastectomy with level III dissection, and postoperative irradiation, the incidence of unilateral arm lymphedema is significantly influenced by several clinicopathological factors like the total number of lymph nodes removed in level III, higher maximal drain output, prolonged duration of drain placement and the presence of lymphovascular invasion.
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Affiliation(s)
- Surjeet Dwivedi
- Department of Surgical Oncology, Command Hospital Air Force, Bengaluru, India
| | - Amiy Arnav
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Deoghar, India
| | - Varun Kumar Agarwal
- Department of Surgical Oncology, Sarojini Naidu Medical College (SNMC), Agra, India
| | - S K Deshpande
- Department of Surgery, Command Hospital Air Force, Bengaluru, India
| | - Rohit Sharma
- Department of Surgical Oncology, Indian Naval Hospital Ship (INHS) Kalyani, Vizag, India
| | - Naresh Saidha
- Department of Surgical Oncology, Command Hospital Air Force, Bengaluru, India
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Desai DJ, Ananda Jyothi VM, Pathak R. Efficacy of Peripheral Nerve Stimulator Guided Pectoral Nerve Block-1 and Serratus Anterior Plane Block for Post-operative Analgesia in Modified Radical Mastectomy: A Randomized Controlled Study. Cureus 2024; 16:e56258. [PMID: 38623125 PMCID: PMC11017237 DOI: 10.7759/cureus.56258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Breast carcinoma is one of the most common cancers in present-day women worldwide, hence surgical intervention for the same is inevitable. General anesthesia being the preferred technique, the selection of appropriate postoperative pain management is a major concern in which superficial fascial plane chest wall blocks play a pivotal role. We aimed to prove the efficacy of peripheral nerve stimulator-guided pectoral nerve-1 (PEC 1) block and serratus anterior plane (SAP) block for postoperative analgesia in modified radical mastectomy. METHODS This prospective randomized controlled clinical study comprised 60 females undergoing modified radical mastectomy and was randomly allocated to two groups. Group A patients received general anesthesia while, in addition to general anesthesia, group B patients received PEC 1 and SAP blocks. Postoperatively the active and passive visual analog score (VAS), duration of analgesia, cumulative requirement of rescue analgesics in the first 24 hours and associated perioperative complications were noted. All quantitative data were analyzed by student t-test and qualitative data by chi-square test using MedCalc software 12.5. RESULTS VAS score for first 24 hours in group B was lower at rest, on pressure over the surgical site as well as on movements compared with the patients in group A with the p-value being < 0.0001 at all time intervals. Time for receiving first rescue analgesia was shorter (1.25±0.56hour vs 20.05±7.78hour, p<0.001) with the significantly higher requirement of cumulative doses of tramadol in the first 24 hours in patients belonging to group A (233.33±47.95mg vs 110±31.62 mg, p<0.001). CONCLUSION PEC 1 and SAP blocks given under peripheral nerve stimulator guidance have a high success rate and are reliable in providing adequate postoperative analgesia for patients undergoing modified radical mastectomy.
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Affiliation(s)
| | | | - Ruchi Pathak
- Anesthesiology, Medical College Baroda, Vadodara, IND
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Faur IF, Dobrescu A, Clim AI, Pasca P, Prodan-Barbulescu C, Gherle BD, Tarta C, Isaic A, Brebu D, Duta C, Totolici B, Lazar G. The Value of Tumor Infiltrating Lymphocytes (TIL) for Predicting the Response to Neoadjuvant Chemotherapy (NAC) in Breast Cancer according to the Molecular Subtypes. Biomedicines 2023; 11:3037. [PMID: 38002037 PMCID: PMC10669335 DOI: 10.3390/biomedicines11113037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION The antitumor host immune response is an important factor in breast cancer, but its role is not fully established. The role of tumor infiltrating lymphocytes (TIL) as an immunological biomarker in breast cancer has been significantly explored in recent years. The number of patients treated with neoadjuvant chemotherapy (NAC) has increased and the identification of a biomarker to predict the probability of pCR (pathological complete response) is a high priority. MATERIALS AND METHODS We evaluated 334 cases of BC treated with NAC followed by surgical resection from 2020-2022 at the Ist Clinic of Oncological Surgery, Oncological Institute "Prof Dr I Chiricuta" Cluj Napoca. Of the above, 122 cases were available for histological evaluation both in pre-NAC biopsy and post-NAC resection tissue. Evaluation of biopsy fragments and resection parts were performed using hematoxylin eosin (H&E). The TIL evaluation took place according to the recommendations of the International TIL Working Group (ITILWG). RESULTS There was a strong association between elevated levels of pre-NAC TIL. At the same time, there is a statistically significant correlation between stromal TIL and tumor grade, the number of lymph node metastases, the molecular subtype and the number of mitoses (p < 0.005). Intratumoral TIL showed a significant correlation with tumor size, distant metastasis, molecular subtype, number of mitosis, stage and lymph node metastasis (p < 0.005). We also demonstrated that high pre-NAC STIL represents a strong predictive marker for pCR. CONCLUSION This study reveals the role of TIL as a predictive biomarker in breast cancer not only for the well-established TNBC (triple negative breast cancer) and HER2+ (Her2 overexpressed) subtypes but also in Luminal A and B molecular subtypes. In this scenario, the evaluation of sTIL as a novel predictive and therapy-predicting factor should become a routinely performed analysis that could guide clinicians when choosing the most appropriate therapy.
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Affiliation(s)
- Ionut Flaviu Faur
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Amadeus Dobrescu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Adelina Ioana Clim
- IInd Obstetric and Gynecology Clinic “Dominic Stanca”, 400124 Cluj-Napoca, Romania;
| | - Paul Pasca
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (C.D.)
| | - Catalin Prodan-Barbulescu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Bogdan Daniel Gherle
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Université de Rennes, 16 Boulevard de Bulgarie, 35000 Rennes, France;
| | - Cristi Tarta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Alexandru Isaic
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Dan Brebu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ciprian Duta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Bogdan Totolici
- Ist Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania;
- Department of General Surgery, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
| | - Gabriel Lazar
- Department of Oncology Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
- Ist Clinic of Oncological Surgery, Oncological Institute “Prof Dr I Chiricuta”, 400015 Cluj-Napoca, Romania
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Senoga A, Wasike R, Ali Mwanzi S, Mutebi M. Quality of life of patients one year after breast-conserving surgery versus modified radical mastectomy for early breast cancer: a Kenyan tertiary hospital five-year review. Pan Afr Med J 2023; 46:69. [PMID: 38282779 PMCID: PMC10822102 DOI: 10.11604/pamj.2023.46.69.39151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/09/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Breast conserving surgery (BCS) followed by radiotherapy (BCT) and modified radical mastectomy (MRM) are the most common surgical techniques utilized in treatment of early breast cancer (EBC) with similar overall survival and recurrence rates. Western literature suggests that these treatments impact the quality of life (QOL) of patients variably. There are no comparison studies on these treatments as per patient's QOL in East Africa. The objectives were to compare the QOL of patients with EBC at least one year after BCT or MRM and assess the factors that affect this QOL. Methods this was a cross-sectional study conducted at Aga Khan University Hospital-Nairobi (AKUHN). Eligible female patients with EBC who had undergone either BCT or MRM between January 2013 and December 2018 were invited to fill out European Organization for the Treatment and Research of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Data on participant demographics and clinical information was also obtained. Average scores for each aspect of QOL were obtained and overall means for each surgical treatment were compared. Linear regression was done to assess the factors that affected this QOL. Results forty-two patients had BCS/BCT and 39 had MRM. Patients who had undergone BCS/BCT had a better overall QOL than those who had undergone MRM (p=0.0149). Multivariate analysis revealed that five years from time of surgery, level of education and diabetes mellitus significantly (p<0.05) affected the QOL of these patients. Conclusion after one year from surgery for EBC, patients who had undergone BCS/BCT had a better QOL as compared to MRM.
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Affiliation(s)
- Andrew Senoga
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Ronald Wasike
- Department of Surgery, Masinde Muliro University Medical School, Kakamega, Kenya
| | - Sitna Ali Mwanzi
- Medical Oncology, Cancer Treatment Center, Kenyatta National Hospital, Nairobi, Kenya
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
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Torabi H, Rodd M, Shirini K. Presentation and treatment of a rare case of metaplastic breast cancer: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231205715. [PMID: 37860279 PMCID: PMC10583507 DOI: 10.1177/2050313x231205715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Breast carcinosarcoma, also known as metaplastic breast cancer, is one of the rarest types of breast cancer. It is an aggressive and poor prognostic breast cancer compared to triple-negative breast cancer. Due to the lack of specific and prescribed treatment, it could threaten patients' lives, especially women worldwide. There are various diagnostic methods, such as multiple imaging and pathology methods, to diagnose breast cancers. Still, considering the common appearance characteristic of this type of breast cancer with other types, histopathology is the most definitive way. There is no standard neoadjuvant or adjuvant chemotherapy for this rare type of breast cancer. In this article, we reported the case of a 62-year-old female with a final diagnosis of metaplastic breast carcinoma and her surgical and medical treatment method.
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Affiliation(s)
- Hossein Torabi
- Department of General Surgery, Poursina Medical and Educational Center, Guilan University of Medical Sciences, Rasht, Gilan Province, Iran
| | - Marjan Rodd
- Department of General Surgery, Poursina Medical and Educational Center, Guilan University of Medical Sciences, Rasht, Gilan Province, Iran
| | - Kasra Shirini
- Department of General Surgery, Iran University of Medical Science, Tehran, Iran
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Mohammed M, Hamza H, Omar MI, Hussein M, Tohamy M, Farouk B, Rezk K. Effect of Clavipectoral Fascia Suturing on Postmastectomy Seroma Formation. Pol Przegl Chir 2023; 96:31-37. [PMID: 38629279 DOI: 10.5604/01.3001.0053.5996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
<b><br>Introduction:</b> Post-mastectomy seroma formation is a challenging sequela which has a negative impact on patient recovery and quality of life.</br> <b><br>Aim:</b> We aim to publicize our technique of clavipectoral fascia re-closure and to assess its efficacy in reducing the incidence of seroma formation.</br> <b><br>Methods:</b> This is a prospective randomized controlled trial, conducted in South Cancer institute, Assiut University, Egypt. It included 84 breast cancer patients who were randomly divided into two groups: a control group (n = 44) and a fascia suture group (n = 40). The patients were followed up until drain removal and then to 3 months after surgery.</br> <b><br>Results:</b> The fascia suture group showed significantly shorter duration of drain removal with a significant reduction in the total amount of drained fluid and the amount of drained fluid 1 week postoperatively. One patient in the fascia suture group developed Grade 2-3 seroma vs. 7 in the control group (P < 0.05).</br> <b><br>Conclusions:</b> Clavipectoral fascia suture technique is a simple and effective method for reducing seroma formation after mastectomy in breast cancer patients and is advisable in patients at a high risk for seroma formation.</br>.
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Affiliation(s)
- Mahmoud Mohammed
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Egypt, Clinical fellow, Worcestershire Royal Hospital NHS Trust, UK
| | - Hesham Hamza
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Egypt
| | - Mohamed I Omar
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Egypt
| | - Mohammed Hussein
- Department of General Surgery, Faculty of Medicine, Assiut University, Egypt
| | - Moaaz Tohamy
- Department of Anesthesia, Intensive Care and Pain Management, South Egypt Cancer Institute, Assiut University, Egypt
| | - Basma Farouk
- Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut University, Egypt
| | - Khalid Rezk
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Egypt
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Zhang Y, Ye F, Teng Y, Zheng J, Li C, Ma R, Zhang H. Radiotherapy dosimetry and radiotherapy related complications of immediate implant-based reconstruction after breast cancer surgery. Front Oncol 2023; 13:1207896. [PMID: 37886175 PMCID: PMC10598640 DOI: 10.3389/fonc.2023.1207896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023] Open
Abstract
Backgrounds The impact of immediate implant-based breast reconstruction (IBBR) on the delivery of radiotherapy plans remains controversial. This study aimed to compare the differences in radiotherapy dosimetry, complications of radiotherapy, and quality of life in patients who underwent modified radical mastectomy combined with or without IBBR. Methods We retrospectively collected 104 patients with breast cancer who underwent intensity-modulated radiation therapy after modified radical mastectomy with IBBR (n =46) or not (n =58) from January 2017 to December 2021. The dosimetric differences in radiotherapy of planning target volume (PTV) and organs at risk and the differences in complications of radiotherapy between the two groups were compared. We also applied the functional assessment of cancer therapy-breast cancer (FACT-B) score to compare the difference in quality of life. The chi-square test and independent samples t-test were used to analyze the above data. Results IBBR group was associated with higher PTV volumes, PTV D98, V95, and lower PTV Dmean, D2 compared with the non-reconstruction group (P<0.05). IBBR group also had lower radiotherapy dosimetric parameters in the ipsilateral lung and the heart of left breast cancer patients. The differences in the rates of radiation pneumonia (RP) and radiation dermatitis (RD) between the two groups were not statistically significant (P > 0.05). Moreover, FACT-B scores at 6 months after radiotherapy in patients with IBBR were higher than those without reconstruction (P < 0.05). Conclusion Patients with IBBR achieved better radiation dosimetry distribution and higher quality of life without more complications of radiotherapy.
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Affiliation(s)
| | | | | | | | | | - Ruilan Ma
- Department of Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haichen Zhang
- Department of Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Kumar R, Mohammed S, Paliwal B, Kamal M, Chhabra S, Bhatia P, Syal R. The midpoint transverse process to pleura (MTP) block for postoperative analgesia in patients undergoing modified radical mastectomy: A case series. J Anaesthesiol Clin Pharmacol 2023; 39:648-650. [PMID: 38269175 PMCID: PMC10805222 DOI: 10.4103/joacp.joacp_147_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/26/2024] Open
Abstract
Among the various regional anesthesia techniques used for postoperative analgesia in the modified radical mastectomy (MRM), thoracic paravertebral block (TPVB) is presently considered the technique of choice. Nevertheless, TPVB may lead to complications like inadvertent vascular puncture, hypotension, epidural or intrathecal spread, pleural puncture, or pneumothorax. Recently, a newer technique "midpoint transverse process to pleura" (MTP) block has been described in which the tip of the needle is placed at the midpoint between the transverse process and pleura. In this case series, we included ten patients of American Society of Anesthesiologist status I/II scheduled for MRM. Ultrasound-guided MTP block was performed and the catheter was inserted on the side of the surgery at the level of T4 level. The block was successful in the all patients as their median visual analogue score at rest and movement was 2 and 3, respectively, in first 24 h postoperatively. Only three patients required rescue analgesia in the first 24 h. No procedural-related complications were noticed in any patient. We concluded that MTP block provided effective perioperative analgesia with minimal rescue analgesia requirement and satisfactory safety profile.
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Affiliation(s)
- Rakesh Kumar
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sadik Mohammed
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharat Paliwal
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manoj Kamal
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Swati Chhabra
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Departments of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rashmi Syal
- Department of Anesthesiology and Critical Care, Dr S.N. Medical College, Jodhpur, Rajasthan, India
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Huang Z, Liu N, Hu S, Ju X, Xu S, Wang S. Effect of Dexmedetomidine and Two Different Doses of Esketamine Combined Infusion on the Quality of Recovery in Patients Undergoing Modified Radical Mastectomy for Breast Cancer - A Randomised Controlled Study. Drug Des Devel Ther 2023; 17:2613-2621. [PMID: 37664451 PMCID: PMC10473051 DOI: 10.2147/dddt.s422896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose This study evaluated the effect of a combined infusion of dexmedetomidine and esketamine on the quality of recovery in patients undergoing modified radical mastectomy. Methods A total of 135 patients were randomly divided into three groups: dexmedetomidine group (group D) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion), dexmedetomidine plus low-dose esketamine group (group DE1) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and esketamine (0.5 mg/kg loading, 2 µg/kg/min infusion), dexmedetomidine plus high-dose esketamine group (group DE2) received dexmedetomidine (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and esketamine (0.5 mg/kg loading, 4 µg/kg/min infusion). The primary outcome was the overall quality of recovery-15 (QoR-15) scores at 1 day after surgery. The secondary endpoints were total QoR-15 scores at 3 days after surgery, propofol and remifentanil requirement, awaking and extubation time, postoperative visual analogue scale (VAS) pain scores, rescue analgesic, nausea and vomiting, bradycardia, excessive sedation, nightmares, and agitation. Results The overall QoR-15 scores were much higher in groups DE1 and DE2 than in groups D 1 and D 3 days after surgery (P < 0.05). VAS pain scores at 6, 12, 24 h postoperatively, propofol and remifentanil requirements were significantly lower in groups DE1 and DE2 than in group D (P < 0.05). Compared with group D, awaking time, extubation time, and post-anesthesia care unit (PACU) stay were significantly prolonged in groups DE1 and DE2 (P < 0.05) and were much longer in group DE2 than in group DE1 (P < 0.05). The proportion of postoperative rescue analgesics and bradycardia was higher and the incidence of excessive sedation was lower in group D than in groups DE1 and DE2 (P < 0.05). Conclusion Dexmedetomidine plus esketamine partly improved postoperative recovery quality and decreased the incidence of bradycardia but prolonged awaking time, extubation time, and PACU stay, especially dexmedetomidine plus 4 µg/kg/min esketamine.
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Affiliation(s)
- Zheng Huang
- Department of Anesthesiology, Bengbu Medical College, Anqing Municipal Hospital, Anqing, People’s Republic of China
| | - Ning Liu
- Department of Anesthesiology, Bengbu Medical College, Anqing Municipal Hospital, Anqing, People’s Republic of China
| | - Shenghong Hu
- Department of Anesthesiology, Bengbu Medical College, Anqing Municipal Hospital, Anqing, People’s Republic of China
| | - Xia Ju
- Department of Anesthesiology, Bengbu Medical College, Anqing Municipal Hospital, Anqing, People’s Republic of China
| | - Siqi Xu
- Department of Anesthesiology, Bengbu Medical College, Anqing Municipal Hospital, Anqing, People’s Republic of China
| | - Shengbin Wang
- Department of Anesthesiology, Bengbu Medical College, Anqing Municipal Hospital, Anqing, People’s Republic of China
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Liu LL, Hu JH, Pan JJ, Liu H, Ji FH, Peng K. An Intraoperative Sub-Anesthetic Dose of Esketamine on Postoperative Depressive Symptoms in Perimenopausal Women with Breast Cancer Undergoing Modified Radical Mastectomy: Protocol for a Randomized, Triple-Blinded, Controlled Trial. Int J Gen Med 2023; 16:3373-3381. [PMID: 37576915 PMCID: PMC10422984 DOI: 10.2147/ijgm.s421265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023] Open
Abstract
Background Depressive symptoms are common among perimenopausal women with breast cancer having modified radical mastectomy. Esketamine exerts antidepressant effects. This study aims to assess whether an intraoperative sub-anesthetic dose of esketamine prevents postoperative depressive symptoms in these patients. Methods In this randomized, triple-blinded, placebo-controlled trial, we will enroll 130 perimenopausal women (aged 45-60 years) with breast cancer undergoing unilateral modified radical mastectomy. Patients will be randomly assigned with a 1:1 ratio to receive either esketamine (0.25 mg/kg i.v.) or normal saline after anesthesia induction and before skin incision. The primary outcome is the incidence of depressive symptoms at day 30 postoperatively, assessed using the Beck's Depression Inventory (BDI). Secondary outcomes include incidence of depressive symptoms and BDI scores at day 1, 3, and 180 postoperatively, anxiety symptoms and scores at day 1, 3, 30, and 180 postoperatively, pain intensity and quality of recovery at day 1 and 2 postoperatively, nausea and vomiting within 48 hours postoperatively, length of postoperative hospital stay, and cancer-specific outcomes. Data will be analyzed in the modified intention-to-treat population. Discussion This is the first trial to evaluate the effects of a sub-anesthetic dose of esketamine on depressive symptoms in perimenopausal women after modified radical mastectomy. The results of this study will help to improve their mental health and recovery after breast cancer surgery. Trial Registration Chinese Clinical Trial Registry (ChiCTR2200064348).
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Affiliation(s)
- Lin-Lin Liu
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jing-Hui Hu
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jing-Jing Pan
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, Guanyun People’s Hospital, Lianyungang, Jiangsu, People’s Republic of China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Fu-Hai Ji
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ke Peng
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
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11
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Shah MH, Batool M. Surviving the Test of Time: A Young Patient's Triumph Over Early-Onset Invasive Ductal Carcinoma and Its Recurrence a Decade Later. Cureus 2023; 15:e42613. [PMID: 37521588 PMCID: PMC10377749 DOI: 10.7759/cureus.42613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/01/2023] Open
Abstract
Breast cancer is a complex, heterogeneous disease with diverse clinical presentations and variable outcomes. In this report, we provide a detailed analysis of a case involving a 22-year-old woman diagnosed with invasive ductal carcinoma, highlighting the difficulties of managing breast cancer in young patients. Through the examination of this patient's 10-year journey, from the initial diagnosis to surgery, adjuvant therapy, and recurrence, we underline the crucial role of early detection, personalised treatment, and interdisciplinary cooperation in optimising patient outcomes. Overall, the case study serves as a compelling narrative, effectively highlighting the aggressive nature of breast cancer in younger individuals and underscoring the need to provide care that addresses the multifaceted dimensions of this disease.
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Affiliation(s)
- Muhammad Hamza Shah
- Medical School, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Mushahida Batool
- General & Breast Surgery, Omar Hospital & Cardiac Centre, Lahore, PAK
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12
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Salafuddin MF, Yarso KY, Nugroho HA, Renardi AS. Breast Conserving Surgery is Better for Sexual Satisfaction Compared to a Modified Radical Mastectomy for Breast Cancer. Asian Pac J Cancer Prev 2023; 24:2083-2088. [PMID: 37378939 PMCID: PMC10505883 DOI: 10.31557/apjcp.2023.24.6.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE This study aimed to determine the difference between the level of sexual satisfaction in breast cancer patients with Modified Radical Mastectomy (MRM) and Breast Conserving Surgery (BCS). METHODS This study used a cross-sectional study using a validated Female Sexual Function Index questionnaire. This study was conducted from 2020 until 2021. Data were collected and analyzed using the chi-square test for bivariate variables and logistic regression for multivariate variables. RESULTS Patients with BCS were more satisfied with their sexual activity than patients undergoing modified radical mastectomy (p = 0.0001, OR 6.25, CI = 2.78 - 14.01). Other factors having effect on sexual satisfactions were: age that showed a statistically effect on sexual satisfaction (patients <55 years were more satisfied than patients ≥55 years ( p = 0.004, OR = 3.23, CI 1.44 - 7.22), the period after operation (<5 years vs >5 years) showed a statistically significant difference in sexual satisfaction ( p = 0.087, OR=0.53, CI = 0.25-1.10), Having chemotherapy treatment showed statistically significant risk for sexual satisfaction (p = 0.003, OR=7.39, CI= 1.62-33.83). Factors having no statistically significant effect on sexual satisfactions were: Radiotherapy treatment (p = 0.133, OR=1.75 and CI = 0.84 -3.64), length of marriage as defined with <10 years and > 10 years (p = 0.616, OR=1.39 and CI = 0.38-5.09), marital status (p = 0.082, OR =0.39, CI=0,13 - 1.16), educational status (p = 0.778, OR = 1.18, CI = 0.37 - 3.75), and work at home vs outside home (p = 0.117, OR=1.8, and CI = 0.86 - 3.78). CONCLUSION BCS as surgical therapy option is the most dominant factor related to sexual satisfaction followed by age group, and chemotherapy group.
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Affiliation(s)
- Muhammad Fahmi Salafuddin
- Oncology Surgeon, Department of Surgery, Sebelas Maret University, Surakarta, Jawa Tengah, Indonesia.
| | - Kristanto Yuli Yarso
- Oncology Surgeon, Department of Surgery, Sebelas Maret University, Surakarta, Jawa Tengah, Indonesia.
| | - Henky Agung Nugroho
- Department of Oncology, Moewardi Hospital, Sebelas Maret University, Surakarta, Jawa Tengah, Indonesia.
| | - Arga Scorpianus Renardi
- Oncology Surgeon, Department of Surgery, Sebelas Maret University, Surakarta, Jawa Tengah, Indonesia.
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13
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Mohite PP, Kanase SB. Effectiveness of Scapular Strengthening Exercises on Shoulder Dysfunction for Pain and Functional Disability after Modified Radical Mastectomy: A Controlled Clinical Trial. Asian Pac J Cancer Prev 2023; 24:2099-2104. [PMID: 37378941 PMCID: PMC10505872 DOI: 10.31557/apjcp.2023.24.6.2099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Breast cancer is the most prevalent from of cancer among women worldwide and leading cause of death. Breast cancer can be treated surgically, systemically (with hormonal therapy, chemotherapy) or with radiotherapy. Through the years, breast cancers management evolved towards conservation surgery. A surgical remove of partial or complete breast tissue, surrounding tissues, and nearby lymph nodes is called mastectomy. In Modified Radical Mastectomy, there is removal of entire breast tissue and lymph nodes. Treatment of modified radical mastectomy may lead to side effects such as shoulder pain, restricted shoulder mobility and anatomical and biomechanical changes of the shoulder, and also reduce functional disability. METHOD Eighty six participants were included in this study. Two groups, each of 43 were made, Group A (control group) was given conventional exercises and Group B (study group) was given scapular strengthening exercises with conventional exercises. Outcome measures - Shoulder Pain And Functional Disability, Shoulder range of motion were assessed both pre and post-test. RESULT Group B had lower pain intensity (77.116 ± 5.798vs 82.837 ± 3.860) and functional disability (70.326 ± 5.281 vs 77.791± 5.102) and higher shoulder flexion (167.98 ± 8.230 vs 107.05 ±8.018), abduction (156.91 ± 8.230 vs 107.63 ±8.230) and external rotation (62.372 ± 7.007 vs 41.907 ±6.771) range of motion than Group A. CONCLUSION The current study concluded that, scapular strengthening exercises along with conventional treatment proved beneficial and effective rather than only conventional treatment on shoulder dysfunction for pain and functional disability after modified radical mastectomy.
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Affiliation(s)
- Prajwalraje Pramod Mohite
- Internee, Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth Deemed To Be University, Karad, Maharashtra, India.
| | - Suraj Bhimrao Kanase
- HOD/ Associate Professor, Department of Neurophysiotherapy, Krishna Vishwa Vidyapeeth Deemed to be University, Karad, Maharashtra, India.
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Aleman Espino A, Bernal IC, Guarecuco JE, El-Tawil R, Masri MM. Adenocarcinoma of the Breast Presenting as Occult Breast Cancer With Axillary and Supraclavicular Lymph Node Metastasis: A Case Report. Cureus 2023; 15:e39583. [PMID: 37384084 PMCID: PMC10293480 DOI: 10.7759/cureus.39583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/27/2023] [Indexed: 06/30/2023] Open
Abstract
Breast cancer is a leading cause of cancer-related mortality in women, with over 250,000 new cases diagnosed annually in the United States. Although mortality rates have decreased, breast cancer remains the second most common cause of cancer death in women. Occult breast cancer (OBC), a rare form of breath cancer that typically presents as axillary lymphadenopathy with no evidence of primary disease, accounts for less than 1% of all breath cancer diagnoses. To date, only three cases of OBC treated with radical mastectomy have been documented in the literature. This case presents a 76-year-old female with a benign left breast mass who was subsequently diagnosed with metastatic estrogen receptor/progesterone receptor (ER/PR)-positive ductal cell breast carcinoma after a visible axillary lymph node was detected on follow-up imaging. Due to the rarity of OBC, standardized treatment guidelines have not been established. Our patient underwent a left radical mastectomy with axillary and cervical lymph node dissection. Clinicians should maintain a high index of suspicion for biopsying axillary lymph nodes in females without evidence of breast malignancy, even though OBC has a low incidence rate. This case report aims to present a documented case of OBC and comprehensibly review the existing literature, discussing the available diagnostic and treatment approaches for this condition. We describe the case of a 76-year-old woman referred to surgery consultation due to a mammographic finding of a left superior lateral mass. The mass was biopsied and found to have no malignancy. On follow-up imaging, she was found to have a left axillary lymph node visible. Her only complaints at this time were breast tenderness and swelling. She underwent fine needle aspiration of the mass, which showed atypical cells that led to an excisional biopsy of the detected axillary node. The biopsy pathology report showed ER/PR-positive ductal cell breast carcinoma. The patient underwent left modified radical mastectomy with left axillary and cervical lymph node dissection. It was during this procedure that the pathology report revealed a 2 cm lesion on the left breast that showed ER/PR-positive infiltrating ductal carcinoma with 32 out of the 37 lymph nodes positive for metastatic disease. This case illustrates the importance of having a low imaging threshold in patients with vague breast symptoms. Surgeons should have a high level of suspicion when metastatic breast cancer is found, even if there is no clinical or radiographic evidence of a primary lesion. This includes conducting lymph node biopsies in patients who present with lymphadenopathy without the initial presence of primary breast cancer. Many studies agree that a modified radical mastectomy with lymph node recession is the treatment of choice for metastatic breast cancer without evidence of primary lesion. However, the efficacy of adjuvant treatments like radiation therapy or chemotherapy should be further studied.
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Affiliation(s)
- Andy Aleman Espino
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Isabel C Bernal
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | | | - Rana El-Tawil
- General Surgery, Larkin Community Hospital, South Miami, USA
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15
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Muacevic A, Adler JR. Descriptive Study and Surgical Management Among Infiltrating Lobular Carcinoma Patients Admitted to King Abdulaziz Medical City From 2000 to 2017: A Retrospective Cross-Sectional Study. Cureus 2023; 15:e35180. [PMID: 36811127 PMCID: PMC9939043 DOI: 10.7759/cureus.35180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/21/2023] Open
Abstract
INTRODUCTION Invasive lobular carcinoma (ILC) is the second most common histologic type of breast carcinoma. The etiology of ILC is unknown; however, many contributing risk factors have been suggested. Treatment of ILC can be divided into local and systemic. Our objectives were to assess the clinical presentations, risk factors, radiological findings, pathological types, and surgical options for patients with ILC treated at the national guard hospital. Identify the factors associated with metastasis and recurrence. METHODS Retrospective cross-sectional descriptive study at a tertiary care center in Riyadh. All adult patients aged 16 years and above, from different nationalities, and both genders, were diagnosed with ILC from 2000 to 2017 and followed up at KAMC. The sampling technique was a non-probability consecutive technique. Among 1066 patients identified, 91 patients were diagnosed with ILC over seventeen years study period. RESULTS The median age at the primary diagnosis was 50. On the clinical examination, 63 (71%) cases were found to have palpable masses which was the most suspicious finding. On radiology, the most encountered finding was speculated masses which were seen in 76 (84%). Regarding the pathology, unilateral breast cancer was seen in 82 while bilateral breast cancer was found only in eight. For the biopsy, a core needle biopsy was the most commonly used in 83 (91%) patients. The most documented surgery for ILC patients was a modified radical mastectomy. Metastasis in different organs was identified with the musculoskeletal system being the commonest site. Different significant variables were compared between patients with or without metastasis. Skin changes, post-operative invasion, estrogen, progesterone, and HER2 receptors were significantly associated with metastasis. Patients with metastasis were less likely to have conservative surgery. Regarding the Recurrence and five years survival, out of 62 cases, 10 had recurrence within five years, which was more prevalent in patients who had fine needle aspiration, excisional biopsy, and nulliparous patients. CONCLUSION To our knowledge, this is the first study to exclusively describe ILC in Saudi Arabia. The results of this current study are highly important, as these results provide baseline data of ILC in the capital city of Saudi Arabia.
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AlBassam B. Combined Thoracic Paravertebral Block-Interscalene Block as a Primary Anesthetic for Modified Radical Mastectomy: A Case Report. Med Arch 2023; 77:326-328. [PMID: 37876557 PMCID: PMC10591238 DOI: 10.5455/medarh.2023.77.326-328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/02/2023] [Indexed: 10/26/2023] Open
Abstract
Background Regional anesthesia as a primary anesthetic can offer merits over general anesthesia for patients having multiple comorbidities who are at a high risk of perioperative morbidity and mortality. Thoracic paravertebral block (TPVB) and interscalene block (ISB) have been used widely to improve the quality of postoperative analgesia after breast surgery. Objective There are limited data on the feasibility of combining TPVB-ISB as a sole anesthetic technique for extensive breast surgery with axillary lymph nodes dissection. Case presentation In this report, the author presented a successful use of a combined TPVB and ISB as a sole anesthetic with conscious sedation in a 52-year-old patient with multiple comorbidities, including heart failure with reduced ejection fraction, who underwent modified radical mastectomy with left axillary lymph nodes dissection. Conclusion Combining TPVB-ISB can be used as a sole anesthetic for extensive breast surgery in patients with a high risk for general anesthesia.
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Affiliation(s)
- Bassam AlBassam
- Department of Anesthesiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Alshawadfy A, Al-Touny SA. Comparing the quality of analgesia with ultrasound-guided pectoral nerve block and serratus anterior plane block II in patients undergoing modified radical mastectomy: a randomised clinical trial. Anaesthesiol Intensive Ther 2023; 55:52-59. [PMID: 37306272 DOI: 10.5114/ait.2023.126218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Despite the recent use of serratus anterior plane (SAP) and pectoral nerve (PECS) blocks for pain management following breast surgery, there are insufficient data comparing their analgesic benefits. This study aimed to compare the quality of analgesia for PECS and SAP blocks in patients having modified radical mastectomy (MRM). MATERIAL AND METHODS This trial enrolled 50 adult female patients scheduled for MRM under anaesthesia. Patients were randomly allocated to two groups. After induction of anaesthesia, 25 patients received US-guided PECS II block, and 25 patients received US-guided SAP block. The primary outcome was the time to first analgesic request. Secondary outcomes included the total analgesic consumption and postoperative pain during the first 24 hours as well as the total time to perform the block, surgeon satisfaction, haemodynamic parameters, and postoperative nausea and vomiting. RESULTS Time to first analgesic request was significantly longer in the SAP group than in the PECS II block group (95% CI: 90.2-574.5, P = 0.009). The SAP block significantly lowered the total analgesics consumption, the 24 hours patient's need for analgesia, and the VAS scores immediately, as well as at 2, 8, 20, 22, and 24 hours postoperatively ( P < 0.005). Although it required a longer preparation time than PECS II block, the SAP block had comparable surgeons' satisfaction, haemodynamic parameters, and post-operative nausea and vomiting to PECS II block. CONCLUSIONS Following MRM, US-guided SAP block provided a delayed time to first rescue analgesia with better acute pain control and lower total analgesic consumption compared to the PECS II block.
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Affiliation(s)
- Abdelrhman Alshawadfy
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Shimaa A Al-Touny
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Muacevic A, Adler JR, Balasubramanian N, Mirunalini G. Patient Comfort During Postop Period in Breast Cancer Surgeries: A Randomized Controlled Trial Comparing Opioid and Opioid-Free Anesthesia. Cureus 2023; 15:e33871. [PMID: 36819361 PMCID: PMC9934931 DOI: 10.7759/cureus.33871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Anesthetic management practices have advanced to opioid-free anesthesia (OFA) often replacing opioids in oncologic surgeries. The study was conducted to find the quality of recovery (QoR) of patients undergoing breast cancer surgeries receiving OFA. METHODS A double-blinded, randomized controlled study was conducted with 60 patients randomized to group OFA and group OA (opioid anesthesia). Group OFA received one-time dosing of ketamine 0.3 mg/kg, lignocaine 1.5 mg/kg, and dexmedetomidine 1 mcg/kg. Group OA received fentanyl 2mcg/kg. Intraoperatively, Group OFA received dexmedetomidine 0.4 mcg/kg/h and the OA group received fentanyl 0.5 mcg/kg/h infusion. Bispectral index (BIS), hemodynamics, muscle relaxant administration, and sevoflurane concentration were noted. A modified QoR-40 score was used to assess the quality of recovery in the postoperative period. RESULTS A higher QoR-40 score was found in the OA group (median 182, IQR 178-186) compared to the OFA group (median 180, IQR 178-184). Out of the five components, the patient's emotional state was better in the group OA (39.9±2.77) than in the OFA group (37.9±2.77). The patient's physical comfort was found to be better in the group OFA (52.52±3.23) compared to group OA (50.93±3.23). Physical independence, psychological support, and pain were comparable between the two groups. Patients in group OFA received less sevoflurane, a muscle relaxant, and showed a mild reduction in heart rate and mean arterial pressure (MAP) when compared to group OA. The time taken to reach a Modified Aldrete score of 9 was high in OFA (11.47±2.16) and (9.17±1.09) when compared to group OA. No significant differences were noted with the visual analog score (VAS) score, Ramsay sedation score, and modified post-anesthesia discharge scoring system (PADSS) score. CONCLUSION We conclude that the quality of recovery of patients receiving opioid-free methods of anesthesia was not inferior to OA in patients undergoing breast cancer surgeries.
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Azam M, Agrawal A, Sahni K, Rastogi M, Rathi AK, Farzana S. Target volume coverage in clinically designed radiotherapy plan of post-mastectomy adjuvant radiotherapy of breast cancer patients in comparison with radiation therapy oncology group-based contoured plan: A dosimetric study. J Cancer Res Ther 2023; 19:159-164. [PMID: 37313897 DOI: 10.4103/jcrt.jcrt_1212_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective Conventional field radiotherapy based on anatomical landmarks has been the traditional treatment for breast cancer. Having proven efficacy, it is still the current standard of treatment. The Radiation Therapy Oncology Group (RTOG) has published guidelines for contouring target volumes in postmastectomy patients. The impact of this guideline in the current clinical practice is less known; hence, we have analyzed dose-volume histograms (DVHs) for these plans and compared them with the proposed treatment plans to treat RTOG-defined targets. Subjects and Methods RTOG consensus definitions were used to contour the target volumes in 20 previously treated postmastectomy patients. The prescription was 42.4 Gy in 16 fractions. DVHs were generated from clinically designed plans that had actually been delivered to each patient. For comparing dose to target volumes, new plans were generated with the goal of covering 95% of volume to 90% of prescribed dose. Results In RTOG contoured Group, coverage improved for the supraclavicular (V90 = 83 vs. 94.9%, P < 0.05) and chest wall (V90 = 89.8 vs. 95.2%, P < 0.05). Axillary nodal coverage improved for Level-1(V90 = 80.35 vs. 96.40%, P < 0.05), Level-II (V90 = 85.93 vs. 97.09%, P < 0.05) and Level III (V90 = 86.67 vs. 98.6%, P < 0.05). The dose to the ipsilateral lung is increased (V20 = 23.87 vs. 28.73%, P < 0.05). Low dose to heart is increased in left-sided cases (V5 = 14.52 vs. 16.72%, P < 0.05) while same in right-sided cases. Conclusions The study shows that radiotherapy using the RTOG consensus guidelines improves coverage to target volumes with a nonsignificant increase in normal organ dose compared to that based on anatomical landmarks.
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Affiliation(s)
- Mohammad Azam
- Department of Radiation Oncology, Maulana Azad Medical College, New Delhi, India
| | - Animesh Agrawal
- Department of Medical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Kamal Sahni
- Department of Radiation Oncology, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Madhup Rastogi
- Department of Radiation Oncology, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Rathi
- Department of Radiation Oncology, Maulana Azad Medical College, New Delhi, India
| | - S Farzana
- Department of Radiation Oncology, Chirayu Medical College, Bhopal, Madhya Pradesh, India
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Zhang J, Ma Q, Li W, Li X, Chen X. S-Ketamine attenuates inflammatory effect and modulates the immune response in patients undergoing modified radical mastectomy: A prospective randomized controlled trial. Front Pharmacol 2023; 14:1128924. [PMID: 36873990 PMCID: PMC9977820 DOI: 10.3389/fphar.2023.1128924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Objective: This study aimed to investigate the impact of varying dosages of S-ketamine on perioperative immune-inflammatory responses in patients undergoing modified radical mastectomy (MRM). Methods: This is a prospective, randomized, controlled trial. A total of 136 patients with American Society of Anesthesiologists status I/II scheduled for MRM were enrolled and randomly assigned into groups to receive the control (C) or one of three different doses [0.25 (L-Sk), 0.5 (M-Sk), or 0.75 (H-Sk) mg/kg] of S-ketamine. The primary outcomes were the cellular immune function and inflammatory factors before anesthesia and at the end of (T1) and 24 h (T2) after the surgery. Secondary outcomes included the visual analog scale (VAS) score, opioid consumption, rate of remedial analgesia, adverse events, and patient satisfaction. Results: The percentage and absolute counts of CD3+ and CD4+ cells in groups L-Sk, M-Sk, and H-Sk were higher than those of group C at T1 and T2. Moreover, a pairwise comparison revealed that the percentage in group H-Sk was higher than those in the L-Sk and M-Sk groups (p < 0.05). The ratio of CD4+/CD8+ was lower in group C at T1 and T2 than those in groups M-Sk and H-Sk (p < 0.05). There was no significant difference in the percentage and absolute counts of natural killer (NK) cells and B lymphocytes among the four groups. However, compared with group C, the concentrations of white blood cells (WBC), neutrophils (NEUT), hypersensitive C-reactive protein (hs-CRP), the neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) at T1 and T2 in three different doses of S-ketamine groups were significantly low, and the lymphocytes were significantly high. The ratio of SIRI and NLR at T2 in group M-Sk was lower than that in group L-Sk (p < 0.05). Additionally, a significant decrease in VAS score, opioid consumption, rates of remedial analgesia, and adverse events was observed in the M-Sk and H-Sk groups. Conclusion: Collectively, our study demonstrates that S-ketamine could reduce opioid consumption, decrease postoperative pain intensity, exert a systemic anti-inflammatory effect, and attenuate immunosuppression in patients undergoing MRM. Moreover, we found that the effects of S-ketamine are related to the dose used, with significant differences observed in 0.5 or 0.75 mg/kg of S-ketamine. Clinical Trial Registration: chictr.org.cn, identifier ChiCTR2200057226.
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Affiliation(s)
- Junxia Zhang
- The Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qian Ma
- The Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Wenbin Li
- Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiaohui Li
- Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xuexin Chen
- Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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B M, Munireddy Papireddy S, P N S, Tarigonda S. A Comparative Study of Placebo Versus Opioid-Free Analgesic Mixture for Mastectomies Performed Under General Anesthesia Along With Erector Spinae Plane Block. Cureus 2023; 15:e34457. [PMID: 36874747 PMCID: PMC9981211 DOI: 10.7759/cureus.34457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Background and objectives Breast cancer is the most frequent cancer among women, globally. Postoperative pain after mastectomy not only causes slow recovery and prolonged hospital stay but can also increase the risk of chronic pain. For patients undergoing breast surgery, effective perioperative pain management is required. Various approaches have been introduced to overcome this, such as opioids, non-opioid analgesics, and regional blocks. The erector spinae plane block is a new regional anesthesia technique used in breast surgery to provide adequate intraoperative and postoperative analgesia. Opioid-free anesthesia is a multimodal analgesia technique that does not use opioids and thus prevents opioid tolerance after surgery. This study aims to investigate whether administering an opioid-free analgesic mixture lowers the pain score and the need for analgesics during and after surgery. Material and methods In this randomized prospective comparative clinical study, 66 patients of the American Society of Anesthesiologists (ASA) psychological status (PS) class 1 and 2, aged 18 to 80, were included. Group M received erector spinae plane block + general anesthesia + opioid-free analgesic mixture (1 mcg/cc dexmedetomidine + 1 mg/cc ketamine + 100 mg/cc magnesium sulfate prepared in a 20 ml syringe). Group N received erector spinae plane block + general anesthesia + 20ml of normal saline infusion. The primary outcome was to assess pain scores in the perioperative period. The secondary outcomes were to compare the time for the first rescue analgesia requirement perioperatively, intraoperative hemodynamic profile, and postoperative patient satisfaction. A p<0.05 was considered to be statistically significant. Results All patients were females undergoing modified radical mastectomy or breast conservative surgery + axillary sampling + latissimus dorsi flap reconstruction. The visual analog scale (VAS) scores were less than or equal to 3 in zero, first, and second hours postoperatively in both groups. The pain was moderate i.e., less than 4 in almost all time intervals in both groups. Group M had a better intraoperative hemodynamic profile, including mean arterial pressure and heart rate when compared to group N. In group M, the time of request for rescue analgesia was 726.67±390.99 minutes, while it was 468±278.79 minutes in group N. The total analgesic requirement was less in group M than in group N, but this was not statistically significant. Conclusion Multimodal analgesia with erector spinae plane block and opioid-free analgesic mixture provides effective perioperative analgesia and a better intraoperative hemodynamic profile in patients undergoing breast cancer surgery under general anesthesia.
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Affiliation(s)
- Monisha B
- Anesthesiology, Sri Devaraj Urs Medical College, Tamaka, IND
| | | | - Sreeramulu P N
- Surgery, R L Jalappa Hospital and Research Centre, Tamaka, IND
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Ahuja D, Kumar V, Gupta N, Jee Bharati S, Garg R, Mishra S, Ahmad Khan M, Bhatnagar S, Bhatnagar S. Comparison of the Efficacy of UltrasoundGuided Serratus Anterior Plane Block Versus Erector Spinae Plane Block for Postoperative Analgesia After Modified Radical Mastectomy: A Randomised Controlled Trial. Turk J Anaesthesiol Reanim 2022; 50:435-442. [PMID: 36511493 PMCID: PMC9885783 DOI: 10.5152/tjar.2022.21127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Several interfascial interfacial plane blocks have been described in patients undergoing modified radical mastectomy. We conducted this study to evaluate the analgesic efficacy of ultrasound-guided serratus anterior plane block and erector spinae plane block in patients undergoing modified radical mastectomy. METHODS Totally, 80 female patients (18-70 years) undergoing modified radical mastectomy were randomised into 2 groups of 40 each and were given ultrasound-guided serratus anterior plane block or erector spinae plane block with 0.4 mL kg-1 of 0.375% ropivacaine in this prospective double-blind control trial. The groups were compared for the time to request of first dose of rescue analgesic, requirement of rescue analgesics, and patient satisfaction score. RESULTS The time to request of the first rescue analgesia was comparable in both groups (P =.056). Postoperative pain scores at rest at 0 minute were significantly lower in serratus anterior plane group as compared to erector spinae plane group (P =.03). The intraoperative fentanyl requirement and postoperative diclofenac and tramadol requirements were comparable between the 2 groups. The number of patients requiring rescue doses of fentanyl intraoperatively and rescue analgesics postoperatively was similar in both groups. The mean patient satisfaction score was also comparable in both groups. CONCLUSION Ultrasound-guided serratus anterior plane block and erector spinae plane block have comparable postoperative analgesic efficacy after modified radical mastectomy.
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Affiliation(s)
- Deepti Ahuja
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,Corresponding author: Vinod Kumar, e-mail:
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Ahmad Khan
- Department of Bio-Statistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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23
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El Sherif FA, Youssef HA, Fares KM, Mohamed SAB, Ali AR, Thabet AM. Efficacy of Ketamine versus Magnesium Sulphate as Adjuvants to Levobupivacaine in Ultrasound Bilevel Erector Spinae Block in Breast Cancer Surgery (a Double-Blinded Randomized Controlled Study). Local Reg Anesth 2022; 15:87-96. [PMID: 36177362 PMCID: PMC9514291 DOI: 10.2147/lra.s379194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Breast surgeons seek simple, safe, effective, and novel regional anesthesia techniques for postoperative analgesia. Erector spinae plane (ESP) block is a new ultrasound-guided technique. We aimed to explore the analgesic effect of adding ketamine and magnesium sulfate as adjuvants to levobupivacaine in ESP. Patients and Methods Sixty female patients (aged 18-60 years) with breast cancer, weighing 50-90 kg who were scheduled for modified radical mastectomy (MRM) were randomly allocated into three groups (20 patients each) to receive an ESP block with 20 mL 0.25% levobupivacaine with adjuvants according to the following groups: group C: levobupivacaine; group K: levobupivacaine + 2 mg/kg ketamine; and group M: levobupivacaine + 2 mg/kg magnesium sulfate. The block was administered preoperatively before anesthesia induction. Postoperatively, hemodynamics, visual analog scale scores, the first request for analgesia, total analgesic consumption, and side effects were observed for 48 hours. Results The total amount of Morphine rescue analgesia was significantly lower in groups M (7.00 ± 0.61 mg) and K (7.50 ± 0.58 mg) than in group C (14.40 ± 3.47 mg) during the first 48 h postoperatively. Nine (45%) patients in group M and 13 (65%) patients in K, compared with 20 (100%) patients in group C, requested analgesia. The time to first request of analgesia was significantly longer in groups M (30 h) and K (24 h) than in group C (7 h). No hemodynamic changes or serious side effects were observed. Conclusion Magnesium sulphate and ketamine seem to be both effective adjuvants to levobupivacaine in ESP blocks for postoperative analgesia in patients undergoing MRM, with slightly better analgesia provided by magnesium sulphate.
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Affiliation(s)
| | | | | | | | - Ali Rabiee Ali
- South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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Lin X, Cai Y, Chen X, Lin J, He Y, Xie L, Jiang X, Chen Y. Analgesia and stress attenuation of ultrasound-guided modified pectoral nerve block type-II with different volumes of 0.3% ropivacaine in patients undergoing modified radical mastectomy for breast cancer: A prospective parallel randomized double-blind controlled clinical trial. J Clin Pharm Ther 2022; 47:1676-1683. [PMID: 35765728 DOI: 10.1111/jcpt.13720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 12/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE A previous randomized clinical trial concluded that an optimal concentration of 0.3% ropivacaine could provide satisfactory analgesia for breast cancer patients undergoing modified radical mastectomy. We wondered if a smaller volume (30 ml vs. 40 ml) of 0.3% ropivacaine could still provide adequate analgesia in an ultrasound-guided PECS II block in modified radical mastectomy. METHODS We performed a prospective parallel randomized double-blind controlled clinical trial. Eligible patients were assigned to either the P30 or P40 group (30 or 40 ml of 0.3% ropivacaine, respectively). The skin area of hypoesthesia, anaesthetic plane determined with ultrasound, pain visual analogue scale (VAS), anaesthetic dosages, and complications were recorded. Serum levels of interleukin-1β and interleukin-6 were measured postoperatively. RESULTS AND DISCUSSION A total of 40 patients completed the trials, with 20 patients in each group. Although the skin area of hypoesthesia and the anaesthetic planes were significantly larger in the P40 group compared with the P30 group (p < 0.05), the VAS, analgesic and opioid doses, serum cytokine levels, anaesthetic toxicity, and complications had no significant differences between the two groups. WHAT IS NEW AND CONCLUSION Compared with 40 ml, 30 ml of 0.3% ropivacaine could provide adequate analgesia and reduce surgical stress in patients undergoing modified radical mastectomy for breast cancer.
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Affiliation(s)
- Xinqiang Lin
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China.,Department of Anesthesiology, Putian Maternity and Child Care Hospital, Putian, Fujian, China
| | - Yuping Cai
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Xiao Chen
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Jianxin Lin
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Yingxi He
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Lijin Xie
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Xiaoling Jiang
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
| | - Yuren Chen
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian, Fujian, China
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Parikshith Manjunath P, Yelamanchi R, Agrawal H, Ekta Yadav E, Gupta N, Gupta AK, Durga C. Effect of Mastectomy Flap Fixation on Post-operative Fluid Drainage and Seroma Formation in Breast Cancer Patients A Double-blinded Randomised Control Trial. Pol Przegl Chir 2022; 95:1-8. [PMID: 36805309 DOI: 10.5604/01.3001.0015.8569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b> Introduction:</b> Post-operative seroma formation is one of the most common complications following modified radical mastectomy (MRM). Quilting is a technique where the mastectomy flaps are sutured to the underlying chest wall muscles with sutures, obliterating the dead space. The authors hypothesised that post-mastectomy dead space obliteration by intermittent mastectomy flap fixation leads to decreased drain output and seroma formation. </br></br> <b> Material and methods: </b> A double-blinded randomised control trial with two arms was conducted from November 2019 to March 2021 in our institute located in India. Patients with non metastatic breast carcinoma planned for MRM were randomly categorised into two groups of 35 patients each. In the test group, each flap was fixed to the underlying muscle using four intermittent 3-0 polyglactin sutures, which was followed by skin closure, and only skin closure was done in the control group. </br></br> <b>Results:</b> The test and control groups did not differ significantly with respect to demographic and tumour characteristics. The average drain output of the test group (155.43 ml) was significantly less than of the control group (206.29 ml). The overall incidence of seroma formation is lower in the test group (5.7%) when compared to the control group (28.6%). The duration of hospital stay in the test group (4.63 days) was significantly shorter when compared to the control group (6.66 days). There was no significant increase in the overall operating time or complications like surgical site infection or skin dimpling due to flap fixation. </br></br> <b>Conclusions:</b> Fixation of MRM flaps is associated with better post-operative outcomes related to drain output and seroma formation without a significant increase in other morbidities or usage of resources.
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Affiliation(s)
- Parikshith Parikshith Manjunath
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Raghav Yelamanchi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Himanshu Agrawal
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ekta Ekta Yadav
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Nikhil Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Arun Kumar Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - C Durga
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Cherian K, Acharya NR, Bhargavan RV, Augustine P, Krishnan JK. Quality of Life Post Breast Cancer Surgery: Comparison of Breast Conservation Surgery versus Modified Radical Mastectomy in a Developing Country. South Asian J Cancer 2022; 11:183-189. [PMID: 36588615 PMCID: PMC9803550 DOI: 10.1055/s-0042-1743420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction Breast cancer survivors are the largest group of female cancer survivors. Oncologic breast surgery can have a profound impact on a woman's body image and sense of self that can significantly affect their quality of life (QOL). The paucity of data about the effect of type of surgery on QOL of Indian breast cancer survivors has led to this study. Materials and Methods This prospective study included consecutive female early breast cancer patients who underwent primary surgery, that is, breast conservation surgery (BCS) or modified radical mastectomy (MRM) from January 1, 2015 to December 31, 2015. The primary objective was the comparison of QOL using European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and EORTC QLQ-BR 23 between the two groups at 6 months and 1 year postsurgery with the baseline. Results One hundred and thirty-eight patients were included of which 62 underwent BCS and 76 underwent MRM. BCS patients fared better with respect to physical functioning, dyspnea, fatigue, appetite loss, and body image at 6 months ( p < 0.05) as compared with MRM. At 1 year postsurgery, BCS patients fared better with respect to physical functioning, role functioning, global health status, body image, sexual enjoyment, and dyspnea, while MRM patients fared better in emotional functioning and future prospectives ( p < 0.05). Conclusion Patients undergoing BCS have a better QOL with respect to various functional and symptom scales at 6 months and 1 year. However, patients undergoing MRM perform better in terms of future perspective and emotional functioning at 1 year.
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Affiliation(s)
- Kurian Cherian
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Nitish Rajan Acharya
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Rexeena V. Bhargavan
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India,Address for correspondence Rexeena V. Bhargavan, MCh Department of Surgical Oncology, Regional Cancer CentreThiruvananthapuram, Kerala, 695011India
| | - Paul Augustine
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Dong B, Yin X, Xu H, Zhou K, Li L, Tian B, Cui R. Application value of modified radical mastectomy in female patients with breast cancer of different molecular types: a prognosis study. Am J Transl Res 2022; 14:2490-2496. [PMID: 35559370 PMCID: PMC9091099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/23/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to explore the application values of modified radical mastectomy in female patients with mammary cancer of different molecular types and from this we conducted a prognosis study. METHODS A total of 204 Breast Cancer (BC) patients who were admitted to our hospital from March 2015 to March 2017 were included and divided into Group A (Luminal A type, n = 68), Group B (Luminal B type, n = 48), Group C (ERBB2: Erb-B2 Receptor Tyrosine Kinase 2 + type, n = 42), and Group D (Basal-like type, n = 46) according to their molecular cancer types. Patients in Groups A and B demonstrated superior treatment efficacy and lower incidence of adverse reactions than those in Groups C and D (P < 0.05), while no statistical difference was observed among the 4 groups in terms of the total operation time, intraoperative blood loss, and postoperative 48-h drainage volume (P > 0.05). Before treatment, the 4 groups exhibited similar results from the EORTC breast cancer-specific quality of life questionnaire (EORTCQLQ-BR23) (P > 0.05). RESULTS After treatment, Group A was superior to the other 3 groups in this regard (P < 0.05). Further, no significant difference was observed among the 4 groups in terms of the prognosis of 3-year survival (P > 0.05). CONCLUSION The clinical application of modified radical mastectomy does not depend on the molecular typing of BC; however, the treatment was more effective in the treatment of Luminal A type BC.
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Affiliation(s)
- Bing Dong
- Department of General Surgery, Jing’an District Central Hospital of Shanghai, Fudan UniversityShanghai 200072, China
| | - Xiaoxing Yin
- Department of General Surgery, Jing’an District Central Hospital of Shanghai, Fudan UniversityShanghai 200072, China
| | - Han Xu
- Department of General Surgery, Jing’an District Central Hospital of Shanghai, Fudan UniversityShanghai 200072, China
| | - Kun Zhou
- Department of General Surgery, Jing’an District Central Hospital of Shanghai, Fudan UniversityShanghai 200072, China
| | - Longzhi Li
- Department of General Surgery, Jing’an District Central Hospital of Shanghai, Fudan UniversityShanghai 200072, China
| | - Baoxing Tian
- Department of General Surgery, Jing’an District Central Hospital of Shanghai, Fudan UniversityShanghai 200072, China
| | - Rongrong Cui
- Department of Breast Surgery, Tongji University Affiliated Yangpu Hospital, Tongji UniversityShanghai 200434, China
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Sulak M, Ahiskalioglu A, Yayik A, Karadeniz E, Celik M, Demir U, Ari M, Alici H. The effect of ultrasound-guided serratus plane block on the quality of life in patients undergoing modified radical mastectomy and axillary lymph node dissection: a randomized controlled study. Anaesthesiol Intensive Ther 2022:46530. [PMID: 35266378 DOI: 10.5114/ait.2022.114203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Modified radical mastectomy (MRM) and axillary lymph node dissection (AD) are the most commonly used surgical methods in breast cancer surgery, and they are characterized by moderate to severe pain. This study aimed to investigate the effect of ultrasound-guided serratus plane block (SPB) on postoperative acute and chronic pain in patients undergoing MRM and AD. METHODS After ethical approval, 60 patients, aged between 18-65 years, ASA I-III, underwent unilateral MRM, and AD was assigned into 2 groups. The SPB group received ultrasound-guided SPB with 30 mL 0.25% bupivacaine, and the control group received 2 mL saline injection subcutaneously. Postoperative analgesia was performed with intravenous patient-controlled analgesia and dexketoprofen trometamol. Pain scores, opioid consumption, and rescue analgesic requirements were recorded. Chronic pain and quality of life were evaluated with the Numerical Rating Scale (NRS), short form-36 (SF-36), and painDETECT. RESULTS Compared with the control group, the visual analogue scale scores were statistically lower in the SPB group during 4 postoperative hours in post-anaesthetic care unit PACU at 1st, 2nd (P < 0.001), and 4th hour (P = 0.014). Fentanyl consumption and rescue analgesics were lower in the SPB group than in the control group (0-4 h, P = 0.001; 4-8 h, 8-12 h, 24 h; total P < 0.001). The incidence of chronic pain was 11%, and there was no statistically significant difference between control and SPB groups in terms of SF-36, NRS, and painDETECT scores measured at the first and sixth months. CONCLUSIONS SPB demonstrated superiority versus the control group concerning acute postoperative pain parameters. However, SPB had no influence on the quality of life and did not prevent chronic postmastectomy pain.
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Xie X, Li H, Wang C, Li W, Xie D, Li M, Jiang D. Effect of modified radical mastectomy combined with neo-adjuvant chemotherapy on postoperative recurrence rate, negative emotion, and life quality of patients with breast cancer. Am J Transl Res 2022; 14:460-467. [PMID: 35173865 PMCID: PMC8829650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
Breast cancer (BC) is mainly treated by surgery combined with chemotherapy, radiotherapy, and drugs comprehensively in clinical practice, and such a combined treatment can improve the survival rate of patients. This study was designed to determine the effect of modified radical mastectomy (MRM) combined with neo-adjuvant chemotherapy on patients with BC. Clinical data of 80 patients with BC were analyzed retrospectively. The patients were assigned to the control group (n=39) treated with MRM or the therapy group (n=41) treated with additional neo-adjuvant chemotherapy based on MRM. In this study, patients treated with MRM combined with neo-adjuvant chemotherapy experienced significantly shorter operation time and hospitalization time, less bleeding volume, and higher effective treatment rate than the control group. Moreover, the therapy group showed a significantly lower incidence of complications and higher life quality than the control group. Cox regression analysis showed that neo-adjuvant chemotherapy was an independent factor affecting the progression-free survival time of patients. This study has revealed the application value of MRM combined with neo-adjuvant chemotherapy in patients with BC.
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Affiliation(s)
- Xianxin Xie
- Department of Breast Surgery, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
- Department of Breast Surgery, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
| | - Huan Li
- Department of Breast Oncology, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
- Department of Breast Oncology, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
| | - Cong Wang
- Department of Breast Surgery, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
- Department of Breast Surgery, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
| | - Weijie Li
- Department of Breast Surgery, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
- Department of Breast Surgery, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
| | - Didi Xie
- Department of Breast Surgery, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
- Department of Breast Surgery, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
| | - Mo Li
- Department of Breast Surgery, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
- Department of Breast Surgery, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
| | - Daqing Jiang
- Department of Breast Surgery, Cancer Hospital of China Medical UniversityShenyang 110042, Liaoning Province, China
- Department of Breast Surgery, Liaoning Cancer Hospital & InstituteShenyang 110042, Liaoning Province, China
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Prajapati S, Ramasamy S, Vats M, Neogi S, Kantamaneni K, Tudu SK. Effect of Octreotide on Lymphorrhea in Patients After Modified Radical Mastectomy for Carcinoma Breast: A Randomized Controlled Trial. Cureus 2021; 13:e19225. [PMID: 34877203 PMCID: PMC8642125 DOI: 10.7759/cureus.19225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Lymphorrhea or seroma formation after modified radical mastectomy (MRM) is a serious and disabling complication of axillary lymphadenectomy. Octreotide is a hormone with general anti-secretory effects. The potential role of octreotide in the treatment of lymphorrhea after axillary lymph node dissection in patients undergoing MRM is being investigated in this study. The purpose of this research is to study the effect of octreotide on the magnitude and duration of lymphorrhea in patients after MRM for carcinoma breast. Methods This clinical trial was registered in the Clinical Trials Registry India (CTRI/2017/11/010653). It was conducted in the Department of General Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi from September 2015 to March 2017. This study is a parallel randomized controlled trial with a 1:1 allocation ratio. Thirty patients were enrolled and allocated equally into two groups. The intervention group received standard medical care plus injection octreotide 100 micrograms eight hourly intravenously post-operatively for five days and the control group received only standard medical care. The primary outcomes were lymphorrhea volume from 24 hours post-surgery till five days post-operatively and the number of days till the suction drain was removed. Secondary outcomes were surgical site infection, the incidence of seroma formation, complications of octreotide, duration of hospital stay, and the number of lymph nodes isolated. All the patients were followed up twice a week for the first six weeks after discharge followed by three monthly visits. Results A total of 30 patients were included in the study. The mean age was 46.2 years. The mean operative time in the control group was 137.87 ± 23.28 minutes and in the octreotide group was 128.13 ± 12.29 (p = 0.163). The volume of lymphorrhea in the control group was 354.67 ± 346.28 ml and in the octreotide group was 194.00 ± 240.62 ml (p = 0.081). Seroma occurred in 9% of patients in the control group and 2 % of patients in the octreotide group (p = 0.010). The duration of lymphorrhea was 4.93 ± 2.49 days in the control group and 3.13 ± 1.36 days in the octreotide group (p = 0.029). The duration of stay was 7.07 ± 2.40 days in the control group and 5.13 ± 1.06 days in the octreotide and was found to be statistically significant (p = 0.010). No obvious adverse reactions related to injection octreotide, namely, nausea, vomiting, abdominal discomfort, hypotension, bradycardia, and dysglycemia, were seen in any of our patients. Conclusion The duration of lymphorrhea, incidence of seroma formation, and duration of hospital stay were lesser in the octreotide group, and the difference was statistically significant. The wound infection rates were similar in both groups. Thus injection octreotide can be used safely and effectively.
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Affiliation(s)
- Sahaj Prajapati
- Pediatric Surgery, Lady Hardinge Medical College, New Delhi, IND
| | | | - Manu Vats
- Surgery, Maulana Azad Medical College, New Delhi, IND
| | | | - Ketan Kantamaneni
- Surgery, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, IND
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Makkar JK, Dahiya D, Jain D, Kuber A, Kajal K, Singh NP. Effect of balanced anaesthesia with and without modified pectoralis nerve block on postoperative analgesia after breast surgeries: A randomised controlled trial. Indian J Anaesth 2021; 65:S110-S114. [PMID: 34703055 PMCID: PMC8500198 DOI: 10.4103/ija.ija_125_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/28/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Modified pectoral nerve block (PEC) has been reported to have variable effects on perioperative pain in patients undergoing surgery for carcinoma breast. This randomised controlled trial was conducted to study the effect of modified PEC on postoperative pain relief in patients undergoing breast surgery. Methods: Fifty patients with carcinoma breast undergoing breast surgery were randomised to receive a modified PEC block consisting of 30 ml of ropivacaine 0.2% after induction of anaesthesia (PEC group) or no block (GA group) in this prospective randomised trial. Time to first rescue analgesia was recorded as primary outcome. Other secondary outcomes recorded were postoperative visual analogue scale (VAS) scores, number of rescue boluses and 24-h fentanyl consumption. Results: There was no significant difference in time to first rescue analgesia between the two groups, with mean difference (95% confidence interval) of 22.91 (−6.8 to 52.69) min. Amount of fentanyl required to keep pain VAS less than 3 was also comparable between the two groups, mean (standard deviation) of 42.0 μg (17.42) in GA group versus 43.24 μg (17.22) in PEC group; P = 0.830.20/25 patients required rescue analgesia in GA group as compared to 17/25 in PEC group (P = 0.334). The postoperative VAS scores were also comparable between the groups at all time intervals. Conclusion: Balanced anaesthesia supplemented with modified PEC block performed after general anaesthesia did not improve the postoperative pain in patients undergoing modified radical mastectomy.
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Affiliation(s)
- Jeetinder K Makkar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Dahiya
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aswini Kuber
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Narinder P Singh
- Department of Neuroanaesthesia, Health Sciences Centre, Winnipeg, Manitoba, Canada
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Srivastava A, Jamil S, Khandelwal A, Raj M, Singh S. Thoracic Epidural Anesthesia for Modified Radical Mastectomy in a High-Risk Patient: A Case Report With Literature Review. Cureus 2021; 13:e15822. [PMID: 34306886 PMCID: PMC8295951 DOI: 10.7759/cureus.15822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
Surgery is one of the mainstays of treatment in breast cancers. Typically, modified radical mastectomy (MRM) is done under general anesthesia (GA). However, GA is not a reasonable choice in patients with multiple comorbidities and difficult airways. Thoracic epidural anesthesia (TEA) is a reasonable and safe alternative to GA as it involves blunting of stress response and avoidance of airway handling apart from hemodynamic stability, lower analgesic consumption, superior postoperative analgesia, reduced postoperative nausea and vomiting, earlier resumption of feeding, and shorter duration of hospitalization. We report a case of advanced breast cancer in a 57-year-old female with a co-existing difficult airway, bronchial asthma, and hypertension in whom MRM was conducted successfully under TEA. We also present a comprehensive review of literature on the use of TEA for MRM.
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Affiliation(s)
- Aarti Srivastava
- Anaesthesiology and Critical Care, Sharda University School of Medical Sciences and Research, Greater Noida, IND
| | - Shaista Jamil
- Anaesthesiology and Critical Care, Sharda University School of Medical Sciences and Research, Greater Noida, IND
| | - Ankur Khandelwal
- Anaesthesiology and Critical Care, Sharda University School of Medical Sciences and Research, Greater Noida, IND
| | - Manish Raj
- Anaesthesiology and Critical Care, Sharda University School of Medical Sciences and Research, Greater Noida, IND
| | - Shalley Singh
- Anaesthesiology and Critical Care, Sharda University School of Medical Sciences and Research, Greater Noida, IND
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Goel N, Jha R, Bhardwaj M, Chawla R. Comparison of Propofol-Dexmedetomidine-Based Intravenous and Sevoflurane-Based Inhalational Anesthesia in Patients Undergoing Modified Radical Mastectomy. Anesth Essays Res 2021; 14:420-424. [PMID: 34092852 PMCID: PMC8159053 DOI: 10.4103/aer.aer_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Aim: Total intravenous anesthesia (TIVA) has proven advantage over inhalational anesthesia in terms of stable hemodynamic, eco-friendly, and good recovery profile, but apprehension regarding adequate depth of anesthesia and intraoperative recall is still pertaining. This study aims to compare propofol–dexmedetomidine-based TIVA with sevoflurane-based inhalational anesthesia in modified radical mastectomy in terms of depth of anesthesia, intraoperative recall, recovery profile, and hemodynamic status. Settings and Design: This prospective randomized controlled study was conducted at a tertiary care center over a time frame of 1 year. Methodology: In this randomized controlled study, 100 patients were randomly distributed into two groups: TIVA (Group T) and inhalational anesthesia (Group I). Group T patients received injection dexmedetomidine: 1 μg.kg−1 over 10 min followed by 0.7 μg.kg−1.h−1 and injection propofol: 25–100 μg.kg−1.min−1. Ventilation was maintained with oxygen–air gas flow. In Group I, patients were ventilated with nitrous oxide–oxygen (50:50) and sevoflurane. Rest of anesthesia for both the groups was same. Primary objective was to achieve adequate depth of anesthesia as monitored by intraoperative bispectral index value (BIS, 40–60). Hemodynamic variables, recovery profile, and amount of individual anesthetic agent consumed were recorded for comparison between two groups. For comparison of scale variables between two groups, independent sample t-test for significant difference between two sample means has been followed. Results: Intraoperative BIS and hemodynamic variables were comparable (P > 0.05). Emergence time was 5.10 min in the TIVA group versus 8.38 min in the inhalational group (P = 0.00). Modified Aldrete score was comparable in two groups (P > 0.05). Cost of TIVA agents consumed per patient was 40% lesser than inhalational agents. Conclusion: TIVA maintains adequate depth of anesthesia along with stable hemodynamic and good recovery profile, at low cost in an eco-friendly manner.
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Affiliation(s)
- Nitesh Goel
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rupam Jha
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manoj Bhardwaj
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rajiv Chawla
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Agarwal S, Bharati SJ, Bhatnagar S, Mishra S, Garg R, Gupta N, Kumar V, Khan MA. The comparison of the efficacy of ultrasound-guided paravertebral block versus erector spinae plane block for postoperative analgesia in modified radical mastectomy: A randomized controlled trial. Saudi J Anaesth 2021; 15:137-143. [PMID: 34188631 PMCID: PMC8191270 DOI: 10.4103/sja.sja_990_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The ultrasound (US)-guided erector spinae plane (ESP) block is a new regional anesthetic technique that offers significant advantages over paravertebral block as it is easy and safe to perform. We aim to compare the efficacy of US-guided paravertebral block with ESP block for postoperative analgesia in modified radical mastectomy (MRM). METHODS Eighty female patients of age group 18-70 years, belonging to physical status American Society of Anesthesiologists (ASA) I and II, undergoing MRM were included in the study. In Group P, patients received paravertebral block and in Group E, patients received ESP block before induction of general anesthesia. Both the groups received 0.5% 20 mL ropivacaine. The time to first rescue analgesia and total doses of rescue analgesics were recorded in the postoperative period. Numeric Rating Scale (NRS) scores at 0 min, 30 min, 1 h, 2 h, 6 h, 12 h, and 24 h were noted, and patient satisfaction was evaluated at 24 h. Unpaired t-test or the Mann-Whitney U test was used to compare quantitative variables while Chi-square test or Fisher's exact test was used to compare qualitative variables. RESULTS The time for the first analgesic request was 232.5 min (140-1200) in ESP group as compared to paravertebral group in which the duration was 205 min (135-1190) (P value = 0.29). The total dose of rescue analgesics and NRS scores in postoperative period were comparable. However, the time to perform ESP block was significantly shorter than that of paravertebral block. CONCLUSION ESP block can be used as a safe and easy to perform alternative analgesic technique over paravertebral block in breast cancer surgeries.
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Affiliation(s)
- Shilpi Agarwal
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
- Address for correspondence: Dr. Sachidanand Jee Bharati, Additional Professor, Department of Onco-Anesthesiology and Palliative Medicine, DR Brairch, AIIMS, New Delhi, India. E-mail:
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
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Deori A, Gupta N, Gupta AK, Yelamanchi R, Agrawal H, Durga CK. A Prospective Randomised Controlled Study Comparing Ultrasonic Dissector with Electrocautery for Axillary Dissection in Patients of Carcinoma Breast. Malays J Med Sci 2021; 28:97-104. [PMID: 33679225 PMCID: PMC7909355 DOI: 10.21315/mjms2021.28.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
Background Axillary dissection is one of the important components of modified radical mastectomy (MRM). The present study was conducted to compare surgical outcomes by using monopolar electrocautery and ultrasonic dissector for axillary dissection in MRM. Methods A parallel randomised controlled single blinded study was conducted with a sample size of 70 patients who were randomised into two groups. One group underwent MRM using ultrasonic dissector (Group A) and the other one using electrocautery (Group B). Intra- and post-operative outcomes were compared. Results Group A had an average operating time of 30.86 min, which was statistically less than that of Group B. The mean mop count and the daily drain output in Group A were less as compared to Group B and the differences were statistically significant. Drain was removed early in Group A as compared to Group B. However, post-operative pain scores and seroma formation were not statistically significant among the two groups. Conclusion Ultrasonic dissector group had significantly lesser intra-operative bleeding, operating time and post-operative drain output when compared to electrocautery group. However, the two groups had no significant difference in post-operative pain scores and seroma formation.
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Affiliation(s)
- Ananya Deori
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Nikhil Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arun Kumar Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Raghav Yelamanchi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Himanshu Agrawal
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - C K Durga
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Du H, Liu X, Li F, Xue Z, Li Y, Qian B. Anesthetic effect of ultrasound-guided multiple-nerve blockade in modified radical mastectomy in patients with breast cancer. Medicine (Baltimore) 2021; 100:e24786. [PMID: 33607831 PMCID: PMC7899908 DOI: 10.1097/md.0000000000024786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Routine anesthesia modality for modified radical mastectomy (MRM) includes general anesthesia (GA), epidural blockade-combined GA and nerve blockade-combined GA. However, GA has been associated with postoperative adverse effects such as vertigo, postoperative nausea and vomiting and requirement for postoperative analgesia, which hinders recovery and prognosis. Moreover, combined blockade of thoracic paravertebral nerves or intercostal nerves and adjuvant basic sedation for massive lumpectomy provided perfect anesthesia and reduced opioid consumption, whereas the excision coverage did not attain the target of MRM. Regional anesthesia strategies involving supplementation of analgesics in ultrasound-guided multiple nerve blocks have garnered interests of clinicians. Nevertheless, the precise effects of intercostal nerves, brachial plexus and supraclavicular nerves in MRM in patients with breast cancer remain obscure. METHODS Eighty female patients with breast cancer scheduled for MRM were recruited in the present trial between May, 2019 and Dec., 2019 in our hospital. The patients ranged from 30 to 65 years of age and 18∼30 kg/m2 in body-mass index, with the American Society of Anesthesiologists I or II. The patients were randomized to ultrasound-guided multiple nerve blocks group and GA group. The patients in multiple nerve blocks group underwent ultrasound guided multiple intercostal nerve blocks, interscalene brachial plexus and supraclavicular nerve blocks, (local anesthesia with 0.3% ropivacaine: 5 ml for each intercostal nerve block, 8 ml for brachial plexus block, 7 mL for supraclavicular nerve block) and basic sedation and intraoperative mask oxygen inhalation. The variations of hemodynamic parameters such as mean arterial pressure, heart rate (HR) and pulse oxygen saturation were monitored. The visual analog scale scores were recorded at postoperative 0 hour, 3 hour, 6 hour, 12 hour and 24 hour in resting state. The postoperative adverse effects, including vertigo, postoperative nausea, and vomiting, pruritus, and urinary retention and so on, as well as the analgesic consumption were recorded. CONCLUSIONS The ultrasound guided multiple intercostal nerve blocks, brachial plexus and supraclavicular nerve blocks could provide favorable anesthesia and analgesia, with noninferiority to GA and the reduced incidence of adverse effects and consumption of postoperative analgesics.
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Sinha C, Kumar A, Kumar A, Kumari P, Singh JK, Jha CK. Deep versus superficial erector spinae block for modified radical mastectomy: A randomised controlled pilot study. Indian J Anaesth 2021; 65:97-101. [PMID: 33776082 PMCID: PMC7983815 DOI: 10.4103/ija.ija_513_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/19/2020] [Accepted: 10/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Forero et al. described two approaches of erector spinae (ES) plane block: superficial and deep to erector spinae muscle. We hypothesised that the superficial technique would not lead to optimum analgesia as the drug would have to cross one more muscle layer. We aimed to compare the techniques in terms of analgesia and sensory blockade in patients undergoing modified radical mastectomy (MRM). Methods: Forty American Society of Anesthesiologists (ASA) I/II female patients in age group 18–60 years undergoing unilateral MRM were included in this prospective study. Group D patients received 20 mL 0.2% ropivacaine deep to erector spinae at the T4 level. Group S patients received 20 mL 0.2% ropivacaine superficial to erector spinae. Sensory level of block, perioperative opioid consumption, and adverse effects were noted. Results: Twenty four hours morphine consumption was less in group D: 5.47 ± 1.1 mg and in group S was 7.66 ± 0.74 mg (P < 0.001). The sensory spread was more in deep group in the posterior axillary and mid axillary line. There were no reported adverse effects in either group. Conclusion: Injection of drug deep to ES muscle provides more cranio-caudal blockade of posterior and lateral chest wall, hence providing better analgesia following breast surgery. Injection of the drug superficial to the muscle leads to inferior analgesia.
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Affiliation(s)
- Chandni Sinha
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Amarjeet Kumar
- Department of Trauma and Emergency (Anaesthesiology), AIIMS, Patna, Bihar, India
| | - Ajeet Kumar
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
| | - Poonam Kumari
- Department of Anaesthesiology, AIIMS, Patna, Bihar, India
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Choudhary S, Gupta N, Misra S, Munnee NN, Kumar A, Ranjan R, Dhar SS, Kumar D, Mourya A, Aggarwal LM. Comparison of two hypofractionated radiotherapy schedules in locally advanced postmastectomy breast cancer patients. J Cancer Res Ther 2021; 16:1331-1335. [PMID: 33342792 DOI: 10.4103/jcrt.jcrt_722_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction The role of hypofractionated radiotherapy (HFRT) in postmastectomy breast cancer patients is not well established. This study was done to establish the role of two different HFRT schedules in the treatment of chest wall and regional lymph nodes after mastectomy. Materials and Methods Between 2012 and 2016, consecutively registered patients of locally advanced breast cancer patients having undergone mastectomy and adjuvant radiotherapy (RT) at a tertiary cancer center were analyzed. Locoregional recurrence (LRR) was the primary endpoint, whereas overall survival (OS), disease-free survival (DFS), and both acute and late adverse events were secondary endpoints. Results A total of 34 patients who were treated with 39 Gy in 13 fractions over 2½ weeks and 35 patients who were treated with 40 Gy in 15 fractions over 3 weeks were identified. The median follow-up period was 47 months and 63.5 months in the 39 Gy and 40 Gy arms, respectively. LRR was seen in 11.8% and 8.6% of patients in the 39 Gy and 40 Gy arms, respectively. OS at 4 years was 66% and 71.5% in the 39 Gy and 40 Gy arms, respectively. The mean DFS for 39 Gy and 40 Gy arms was 43.6 months and 66.4 months, respectively (P = 0.822). Acute skin toxicity was similar in the two groups. Arm edema was significantly more in the 40 Gy arm. Conclusion The two HFRT schedules are equivalent to each other in terms of survival outcomes. Arm edema is higher with 40 Gy arm as compared to 39 Gy arm.
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Affiliation(s)
- Sunil Choudhary
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Neha Gupta
- Department of Radiation Oncology, Apex Cancer Institute, Apex Hospital, Varanasi, Uttar Pradesh, India
| | - Shagun Misra
- Department of Radiotherapy, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Amit Kumar
- Department of Radiotherapy, National Cancer Institute, Jajjhar, Haryana, India
| | - Rakesh Ranjan
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | - Deepak Kumar
- Department of Radiotherapy, AIIMS, New Delhi, India
| | - Ankur Mourya
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Lalit Mohan Aggarwal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Zhu L, Zhang Z, Zhang S, Jiang X, Ni Y. A novel balanced anesthesia shortens time to emergence in patients undergoing modified radical mastectomy: a randomized prospective trial. Ann Palliat Med 2021; 10:2439-2447. [PMID: 33440972 DOI: 10.21037/apm-20-1774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/15/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND In balanced anesthesia, protocol during the last 30 min is very important to guarantee rapid emergence and smooth extubation. In clinical practice, sevoflurane and propofol are often used in combination to achieve a better anesthetic effect and less adverse reaction. Approximately 30 min before surgical completion, sevoflurane inhalation is often discontinued and propofol is adjusted to keep sufficient depth of anesthesia. However, propofol-based anesthesia may delay time to emergence due to its unpredictable interindividual variability. In contrast, sevoflurane can be rapidly excreted unchanged from the respiratory tract, and more importantly, with minimal variability. This study aimed to investigate the effect of a novel balanced anesthesia protocol, that is propofol-based intravenous induction, propofol-sevoflurane combined maintenance, and total sevoflurane inhalation during the last 30 min of the surgery, on the time to emergence/extubation. METHODS In our study, a total of 100 female patients undergoing modified radical mastectomy were enrolled. All patients received propofol-based intravenous anesthesia for induction followed by propofolsevoflurane combined maintenance. Approximately 30 min before the end of surgery, sevoflurane was continually inhaled without propofol infusion in group Sev (n=50), while propofol was only infused in group Pro (n=50). The primary outcome was the time to emergence/extubation. The second outcomes included time to respiratory recovery, and duration of post-anesthesia care unit (PACU) stay. The hemodynamic parameters and incidences of postoperative adverse events such as hypoxemia, nausea, vomiting, dizziness, and emergence agitation (EA) were also assessed. RESULTS The time to emergence/extubation in group Sev was shorter than that in group Pro (12.74±4.31 vs. 17.74±4.27 min, P<0.0001). Similarly, time to respiratory recovery, and duration of PACU stay were significantly shortened in group Sev (all P<0.0001). Most of the patients in group Sev were extubated under a totally waking state of consciousness. The hemodynamic parameters and incidences of postoperative hypoxemia, nausea, vomiting, dizziness, and EA during the PACU stay were similar between the two groups. CONCLUSIONS In patients undergoing modified radical mastectomy, this novel balanced anesthesia method could shorten the time to emergence/extubation and better waking state without increasing the incidence of adverse events.
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Affiliation(s)
- Linjia Zhu
- Department of Anesthesiology and Perioperative medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhenfeng Zhang
- Department of Anesthesiology and Perioperative medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Sibi Zhang
- Department of Anesthesiology and Perioperative medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiuhong Jiang
- Department of Anesthesiology and Perioperative medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yan Ni
- Department of Anesthesiology and Perioperative medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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Zhao Y, Zhu J, Zhang X, Wu G, Xu Y, Shen P, Wei X, Kong D, Ji S, Yang B. Integrated IMRT vs segmented 3D-CRT of the chest wall and supraclavicular region for Breast Cancer after modified Radical Mastectomy: An 8-year follow-up. J Cancer 2021; 12:1548-1554. [PMID: 33532000 PMCID: PMC7847649 DOI: 10.7150/jca.51125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/14/2020] [Indexed: 12/09/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the efficacy of two radiotherapy techniques for breast cancer patients with post-mastectomy. The intensity-modulated radiotherapy for treating the chest wall and regional nodes contoured as a whole planning target volume was compared with the conventional segmented 3-dimensional conformal radiotherapy undergoing modified radical mastectomy. Materials and methods: Patients who received the two post-mastectomy radiation therapies were retrospectively analyzed. The chest wall and supra/infraclavicular region +/- internal mammary nodes were contoured as a whole planning target volume on the planning computed tomography. We evaluated differences in survival, recurrence, and late side effects between the integrated intensity-modulated radiotherapy group and the conventional segmented group. Results: A total of 223 patients were recruited. The mean follow-up was 104.3 months. Of these patients, 129 received integrated radiotherapy and 94 patients received segmented radiotherapy. The 8-year disease-free survival rates were 86.0% and 73.4% for patients treated with integrated radiotherapy and traditional segmented radiotherapy, respectively (P = 0.022). The 8-year overall survival rates were 91.4% and 86.2% for patients treated with integrated radiotherapy and traditional segmented radiotherapy, respectively (P = 0.530). Multivariate analysis demonstrated that radiotherapy was an independent prognostic factor for disease-free survival. No significant difference was observed in late side-effects between the two groups. Conclusion: Intensity-modulated radiotherapy for treating the chest wall and regional nodes contoured as a whole planning target volume reduces the recurrence rate for post-mastectomy breast cancer patients with tolerable toxicities.
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Affiliation(s)
- Yutian Zhao
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
| | - Jiahao Zhu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
| | - Xiaojun Zhang
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
| | - Gang Wu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
| | - Yu Xu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
| | - Peipei Shen
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
| | - Xianding Wei
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
| | - Dong Kong
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
| | - Shengjun Ji
- Department of Radiotherapy and Oncology, Suzhou Municipal Hospital, Suzhou, Jiangsu 215000, P.R. China
| | - Bo Yang
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, P.R. China
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Memon F, Ahmed A, Parveen S, Iqbal S, Anwar A, Hashmi AA. Outcomes of Harmonic Scalpel and Electrocautery in Patients Who Underwent Modified Radical Mastectomy. Cureus 2020; 12:e12311. [PMID: 33520510 PMCID: PMC7835401 DOI: 10.7759/cureus.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective This study aimed to compare the mean operative time, total analgesic required, and the mean number of drainage days in harmonic scalpel versus electrocautery in breast cancer patients undergoing modified radical mastectomy (MRM). Methodology This retrospective cross-sectional study was conducted in the Department of General Surgery, Jinnah Postgraduate Medical Center (JPMC). The duration of the study was six months, from January 2018 until July 2018. A total of 194 females with biopsy-proven breast cancer undergoing MRM were included in the study. They were divided into two groups. In group 'A', a harmonic scalpel was used, and in group 'B', electrocautery was used for hemostasis. Results The mean age of the participants was 48.68 ±10.04 years. The mean operative time was 102.13 ±2.04 minutes. The mean number of days of drainage was 1.27 ±2.63. The mean analgesia amount was 30.72 ±3.25 mg. In the harmonic scalpel group, the mean operative time was 100.43 ±0.89 minutes, whereas, in the electrocautery group, it was 103.86 ±1.12 minutes with a significant difference (p=0.001). In the harmonic scalpel group, the mean number of drainage days was 8.90 ±0.42, whereas, in the electrocautery group, it was 13.58 ±1.26 with a statistically significant difference (p=0.001). In the harmonic scalpel group, the mean analgesia amount was 1,800.5 ±353.55 mg, whereas, in the electrocautery group, it was noted to be 2,006.25 ±289.43 with a statistically significant difference (p=0.001). Conclusion This study concludes that compared with standard electrocautery, harmonic scalpel dissection is associated with significant benefits in decreasing postoperative drainage and blood loss during operations after MRM for breast cancer.
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Affiliation(s)
- Farhana Memon
- General Surgery, Sir Syed Medical College, Karachi, PAK
| | | | - Sughra Parveen
- General Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Sadaf Iqbal
- General Surgery, Baqai Medical University, Karachi, PAK
| | - Adnan Anwar
- Physiology, Al-Tibri Medical College, Isra University, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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Kumar V, Sirohiya P, Gupta N, Bharati SJ, Garg R, Mishra S. Effect of adding dexamethasone to ropivacaine for ultrasound-guided serratus anterior plane block in patients undergoing modified radical mastectomy: A preliminary trial. Indian J Anaesth 2020; 64:1032-1037. [PMID: 33542566 PMCID: PMC7852438 DOI: 10.4103/ija.ija_261_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/19/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Ultrasound-guided serratus anterior plane (SAP) block is a field block with high efficacy. We studied the analgesic effect of the addition of dexamethasone to ropivacaine in SAP block for modified radical mastectomy (MRM). METHODS Sixty patients undergoing MRM were randomised into two groups. Patients in Group P (n = 30) received 0.375% ropivacaine (0.4 ml/kg) with normal saline (2 ml) and those in group D (n = 30) received 0.375% ropivacaine (0.4 ml/kg) with 8 mg of dexamethasone (2 ml) in ultrasound-guided SAP block. The primary objective was to compare the time to first rescue analgesia and the secondary objectives were to compare the intraoperative fentanyl requirement, total diclofenac and tramadol requirements, and occurrence of nausea and vomiting in 24 hours, postoperatively. The statistical analysis was done using Mann-Whitney U-test, Chi-square test, Fisher's exact test, and Kaplan Meier survival estimates. RESULTS More patients required rescue analgesia in 24 hours in group P (33%) than group D (10%, P = 0.04). The probability of a pain free-period was significantly higher in group D than group P (P = 0.03, log-rank test). Intra-operative fentanyl requirement and postoperative diclofenac and tramadol requirements were comparable in both the groups. The incidence of postoperative nausea and vomiting was significantly more in Group P than Group D. CONCLUSION Addition of dexamethasone to ropivacaine for SAP block increases the time to first rescue analgesic in the postoperative period.
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Affiliation(s)
- Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
| | - Prashant Sirohiya
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute (Jhajjar), AIIMS, New Delhi, India
- Address for correspondence: Dr. Prashant Sirohiya, Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute (Jhajjar), AIIMS, New Delhi, India. E-mail:
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
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Wu H, Huang Y. Negative lymph node count is an independent prognostic factor for female patients with node positive breast cancer. Transl Cancer Res 2020; 9:7450-7457. [PMID: 35117345 PMCID: PMC8799285 DOI: 10.21037/tcr-20-2351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/28/2020] [Indexed: 11/07/2022]
Abstract
Background Negative lymph node (NLN) count has been reported to associate with the prognosis of various cancers. This study aims to reveal the prognostic value of NLN count in breast cancer. Methods Clinical characteristics of patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. The X-tile program was used to determine the optimal cutoffs for NLN count. Univariate and multivariate analysis were used to assess the risk factors for breast cancer-specific survival (BCSS). Results The X-tile program identified that cutoff value of 2 and 10 could divide the patients into high, middle and low risk subgroups. According to multivariate analysis, patients with NLN count ≤1, over 60 years old, being black, higher tumor grade, higher T or N stage, negative hormone receptor, no radiotherapy or no chemotherapy would more likely suffer poor survival outcome. Subgroup analysis showed that NLN count could still predict survival independently. Conclusions NLN count is a potentially effective predictor of breast cancer and is a good supplement for N stage and TNM stage. Combining NLN count with other prognostic factors will be a better predictor for the survival of breast cancer patients.
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Affiliation(s)
- Hao Wu
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yajing Huang
- Department of Breast and Thyroid Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bhan S, Mishra S, Gupta N, Garg R, Vig S, Thulkar S, Kumar R, Bhatnagar S. A Prospective Randomised Study to Assess the Analgesic Efficacy of Serratus Anterior Plane (SAP) Block for Modified Radical Mastectomy Under General Anaesthesia. Turk J Anaesthesiol Reanim 2020; 49:124-129. [PMID: 33997841 PMCID: PMC8098724 DOI: 10.5152/tjar.2020.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/27/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Breast cancer is the most common malignancy among women and often requires surgery for the removal of the tumour. Uncontrolled pain after breast surgeries is a common problem. Serratus anterior plane (SAP) block is a recently designed technique to block the lateral cutaneous branches of the ventral rami of thoracic intercostal nerves and may cover the area of surgical dissection for modified radical mastectomy (MRM). The primary objective of this study was to evaluate the effect of SAP block on the time to first rescue analgesic in the post-operative period in patients undergoing MRM. Methods A randomised, single-blind, parallel group trial was conducted in a single teaching hospital. A total of 100 patients undergoing MRM were randomised in a 1:1 ratio into 2 groups: MRM under general anaesthesia (GA) alone (group G, n=50) or GA with SAP block (group S, n=50). Blocks were performed under ultrasound guidance at the level of the 5th rib in the midaxillary line with 0.4 mL kg−1 of 0.375% ropivacaine. Results The time to request of first rescue analgesia was significantly prolonged in group S compared with group G (p=0.008). Median (interquartile range) for time to rescue analgesia in group S was 120 (60–300) min, whereas in group G, it was 60 (15–120) min. Post-operative pain scores and the number of patients requiring intra-operative additional fentanyl were significantly less in group S. No technique-related adverse events were observed. Conclusion SAP block improved perioperative analgesia in patients undergoing MRM. Clinical trial registry number CTRI/2017/11/010424. (http://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1&compid=19&EncHid=45912.14862)
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Affiliation(s)
- Swati Bhan
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.,Department of Onco-Anaesthesiology and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Sanjay Thulkar
- Unit of Radio diagnosis, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Scientist - II (statistics), Delhi State Cancer Registry, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Elsabeeny WY, Shehab NN, Wadod MA, Elkady MA. Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial. J Pain Res 2020; 13:2885-2894. [PMID: 33209056 PMCID: PMC7669532 DOI: 10.2147/jpr.s274808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Various analgesic modalities are adopted for perioperative analgesia in breast cancer surgeries. This study aimed to compare the efficacy of intravenous morphine versus serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in breast cancer surgeries. Patients and Methods Seventy-five breast cancer patients undergoing modified radical mastectomy from January 2020 to June 2020 were randomly allocated into 3 groups; the morphine group received morphine 0.1 mg/kg, the SAPB group received ultrasound-guided SAPB with 25 mL bupivacaine 0.25% and the ESPB group received ultrasound-guided ESPB with 25 mL bupivacaine 0.25%. A visual analogue scale (VAS) 0–10 was used to evaluate pain postoperatively, where 0 denotes no pain and 10 worst pain. If any patient in the 3 studied groups reported breakthrough pain with VAS ≥ 4 then a bolus of 3 mg morphine was given. Results There was no difference in VAS scores between the 3 groups postoperatively. Morphine consumption was higher in the morphine group (9.19 ± 2.32 mg) than the SAPB group (4.00 ± 1.55 mg) and the ESPB group (4.20 ± 1.64 mg), respectively. First time to receive postoperative morphine was significantly longer for the ESPB and SAPB groups than the morphine group (20.40 ± 4.98 hours), (19.00 ± 5.9 hours), (5.00 ± 4.62 hours), respectively. Intraoperative hemodynamics and fentanyl consumption showed no difference between groups, whereas postoperative mean arterial blood pressure values at 2 and 4 hours were higher in the morphine group. Ramsay sedation score and postoperative nausea and vomiting values in the post anesthesia care unit were higher for the morphine group compared to the SAPB and ESPB groups. No complications related to the blocks were reported. Conclusion SAPB and ESPB can be used as an effective and safe alternative to opioids with fewer side effects in breast cancer patients undergoing modified radical mastectomy. Trial Registration This trial was prospectively registered at Clinical Trials.gov on 22 January 2020 with registration number NCT04248608 (https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JS5&selectaction=Edit&uid=U0004LIG&ts=7&cx=−81xkwa).
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Affiliation(s)
- Walaa Y Elsabeeny
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nahla N Shehab
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed A Wadod
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mostafa A Elkady
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
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Abu Elyazed MM, Abdelghany MS, Mostafa SF. The Analgesic Efficacy of Pecto-Intercostal Fascial Block Combined with Pectoral Nerve Block in Modified Radical Mastectomy: A Prospective Randomized Trial. Pain Physician 2020; 23:485-493. [PMID: 32967391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pectoral nerve (Pecs) block is one of the most promising regional analgesic techniques for breast surgery. However, Pecs II block may not provide analgesia of the medial aspect of the breast or the entire nipple-areolar complex. OBJECTIVES The aim of the present study was to investigate the efficacy of combining the pecto-intercostal fascial block (PIFB) and Pecs II block for perioperative analgesia following modified radical mastectomy (MRM). STUDY DESIGN A prospective randomized study. SETTING An academic medical center. METHODS Sixty women undergoing unilateral MRM were randomly divided into 2 groups. The Pecs II group received Pecs II block using 20 mL bupivacaine 0.25% between the serratus anterior and the external intercostal muscles, and 10 mL bupivacaine 0.25% between the pectoralis major and minor muscles, together with sham PIFB using 15 mL normal saline solution in the interfascial plane between the pectoralis major muscle and the external intercostal muscle. PIFB-Pecs II group received the same Pecs II block combined with PIFB using 15 mL bupivacaine 0.25%. RESULTS The median (interquartile range [IQR]) time to the first morphine dose was significantly longer in the PIFB-Pecs II group (327.5 [266.3-360.0] minutes) than the Pecs II group (196 [163.8-248.8] minutes) (P < 0.001, 95% confidence interval [CI] 79.98, 150.00).The median (IQR) cumulative morphine consumption was higher in the Pecs II group (14.0 [11.0-18.0] mg) than the PIFB-Pecs II group (8.0 [7.0-9.0] mg) (P < 0.001; CI, 4.0-8.0). Intraoperative consumption of fentanyl was significantly lower in PIFB-Pecs II group with a median (IQR) of 0 (0-15 mu g) than the Pecs II group median 57.5 (0-75 mu g) (P = 0.022, CI; 0-60). The Visual Analog Scale scores for the first 12 postoperative hours were lower in the PIFB-Pecs II group than the Pecs II group at rest and on moving the ipsilateral arm (P < 0.001). The dermatomal block on the lateral chest wall was comparable between the 2 studied groups. PIFB-Pecs II provided extensive sensory block on the anterior chest wall, whereas Pecs II block failed to achieve any sensory block. LIMITATIONS This study was limited by its small sample size. CONCLUSIONS The combination of Pecs II and PIFB provide better perioperative analgesia for MRM than Pecs II alone.
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Affiliation(s)
- Mohamed M Abu Elyazed
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed S Abdelghany
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Shaimaa F Mostafa
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
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Deng W, Fu D, He L. Evaluation of Pectoral Nerve Block in Modified Radical Mastectomy: Comparison of Three Concentrations of Ropivacaine. Clin Interv Aging 2020; 15:937-944. [PMID: 32606635 PMCID: PMC7319529 DOI: 10.2147/cia.s251613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022] Open
Abstract
Background Pectoral nerve block type I (PECS I Block) and type II (PECS II Block) with ropivacaine are relatively new analgesic methods for breast-cancer surgery. We evaluated the safety and efficacy of different concentrations of ropivacaine given in the same volume for the PECS II Block in patients undergoing modified radical mastectomy (MRM). Patients and Methods One hundred and twenty women undergoing elective MRM who met inclusion criteria were divided randomly into four groups of 30: control group without PECS II Block and R0.2%, R0.3%, and R0.4% groups, who received general anesthesia plus the PECS II Block with ropivacaine at 0.2%, 0.3%, and 0.4%, respectively, in a volume of 40 mL. Results The postoperative numerical rating scale (NRS) pain score at rest and active was significantly higher in the control group than that in the three ropivacaine groups (P<0.05 for all), and the postoperative NRS score in the R0.3% group and R0.4% group at 12, 24, and 48 h postoperatively were significantly lower than that in the R0.2% group (P<0.05 for all); there was no significant difference between the R0.3% group and R0.4% group. The time when pain was first felt after MRM, the total number of complaints during 3, 6, 12, 24, and 48 h after MRM, and the total analgesic requirement (tramadol consumption) during the first 24 h postoperatively in the R0.3% group and R0.4% group were significantly lower than those in the control group and R0.2% group (P<0.05 for all); there was no significant difference between the R0.3% group and R0.4% group. Conclusion A dose of 0.3% ropivacaine was the optimal concentration for a PECS II Block for patients undergoing MRM because it provided efficacious analgesia during and >48 h after MRM. Increasing the ropivacaine concentration did not improve the analgesia of the PECS II Block significantly.
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Affiliation(s)
- Wei Deng
- Department of Anesthesiology, The First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), Jiaxing, People's Republic of China
| | - Dan Fu
- Department of Paediatrics, Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
| | - Liang He
- Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Guilin, People's Republic of China
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Song WQ, Wang W, Yang YC, Sun Q, Chen H, Zhang L, Bu XS, Zhan LY, Xia ZY. Parasternal Intercostal Block Complementation Contributes to Postoperative Pain Relief in Modified Radical Mastectomy Employing Pectoral Nerve Block I and Serratus-Intercostal Block: A Randomized Trial. J Pain Res 2020; 13:865-871. [PMID: 32431534 PMCID: PMC7201222 DOI: 10.2147/jpr.s237435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/18/2020] [Indexed: 01/12/2023] Open
Abstract
Purpose Pectoral nerve block I (PECS I) and serratus-intercostal plane block (SIPB) can anesthetize the majority mammary region, while parasternal intercostal block (PSI) targets the internal area during breast resection surgery. The aim of this study was to determine whether including PSI with PECS I and SIPB is more effective compared to PECS I and SIPB alone. Patients and Methods Sixty-two adult females undergoing unilateral modified radical mastectomy (MRM) were randomly assigned to receive either PECS I and SIPB (PS group, n=31) or a combination of PECS I, SIPB, and PSI (PSP group, n=31). The outcomes were measured with a numerical rating scale (NRS) score, and in terms of opioid consumption and anesthesia-related complications within 48 h after surgery. Results Although there were no differences in the NRS scores between the two groups during the inactive periods, the combination of three nerve blocks significantly reduced the NRS scores during movement. In addition, morphine equivalent consumption was lower in the PSP group compared to the PS group. Postoperative adverse events were similar in both groups in terms of regional anesthesia-related complications. Conclusion The combination of PECS I block, SIPB, and PSI block provides superior pain relief and postoperative recovery for patients undergoing MRM.
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Affiliation(s)
- Wen-Qin Song
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Wei Wang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Ying-Cong Yang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Qian Sun
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Hui Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Lei Zhang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Xue-Shan Bu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Li-Ying Zhan
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zhong-Yuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
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El Sherif FA, Abd El-Rahman AM, Othman AH, Shouman SA, Omran MM, Hassan NA, Hassan SB, Aboeleuon E. Analgesic Effect of Morphine Added to Bupivacaine in Serratus Anterior Plane Block Following Modified Radical Mastectomy. Only a Local Effect? Randomized Clinical Trial. J Pain Res 2020; 13:661-668. [PMID: 32280268 PMCID: PMC7127777 DOI: 10.2147/jpr.s236336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Serratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves the anterolateral chest wall. Opioid receptors have been found on peripheral nerve terminals, so morphine may have a local action. Objective This work aimed at exploring the analgesic efficacy of morphine added to bupivacaine in SAPB in patients for whom modified radical mastectomy was conducted and whether it is a mere local effect. Methods Forty female patients were planned to have modified radical mastectomy participated in the study. Patients were randomly divided into two groups; Control group (C): received ultrasound-guided serratus anterior plane block with 20 mL of bupivacaine hydrochloride 0.25%; Morphine group (M): received the same in addition to 10 mg morphine sulfate. Intra- and post-operative blood samples were taken for the assessment of morphine serum levels. All patients were assessed for VAS scores during rest and movement (VAS-R and VAS-M). Time to the first request and the total amount of the rescue analgesia were recorded. Results In group M, Morphine was not detected in the plasma of all patients. Both VAS-R and VAS-M were significantly higher in group C than in group M (P<0.001) and (P≤0.003), respectively. Time to the first request of rescue analgesia was 8.5 h in group C compared to 20 h in group M (P=0.005) with a median dose of acetaminophen consumption of 2 g in group C compared to 1 g in group M (P=0.006). Conclusion Ten mg of morphine, when added to bupivacaine in SAPB, improved postoperative analgesia in patients to whom modified radical mastectomy was conducted. This effect seems to be attributed merely to local mechanisms. Registration The registration number of this study is NCT02962024 at www.clinicaltrial.gov.
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Affiliation(s)
- Fatma A El Sherif
- Anesthesia, ICU, and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ahmad M Abd El-Rahman
- Anesthesia, ICU, and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ahmed H Othman
- Anesthesia, ICU, and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Samia A Shouman
- Cancer Biology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mervat M Omran
- Cancer Biology (Pharmacology and Experimental Oncology), National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nivin A Hassan
- Cancer Biology (Pharmacology and Experimental Oncology), South Egypt Cancer Institute, Assuit University, Assiut, Egypt
| | - Sahar B Hassan
- Clinical Pharmacy, Faculty of Pharmacy, Assuit University, Assiut, Egypt
| | - Ebrahim Aboeleuon
- Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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Qiu H, Xu WH, Kong J, Ding XJ, Chen DF. Effect of breast-conserving surgery and modified radical mastectomy on operation index, symptom checklist-90 score and prognosis in patients with early breast cancer. Medicine (Baltimore) 2020; 99:e19279. [PMID: 32176051 PMCID: PMC7220131 DOI: 10.1097/md.0000000000019279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The present study aims to analyze the effects of breast-conserving surgery and modified radical mastectomy on operation indexes, Symptom checklist-90 scores and prognosis in patients with early breast cancer.The clinical data of 128 patients with breast cancer who were treated in our hospital from May 2015 to May 2016 were included into the analysis. These patients were divided into 2 groups, according to the different modes of operation (n = 64): control group, patients underwent modified radical mastectomy; observation group, patients underwent early breast conserving surgery. Then, the surgical indexes and prognosis were compared between these 2 groups.Intraoperative bleeding volume, incision length and hospitalization duration were better in the observation group than in the control group (P < .05). Furthermore, postoperative symptom checklist-90 scores in the observation group were better than scores before the operation, and were better than the scores in the control group (P < .05). Moreover, the incidence of postoperative complications was lower in the observation group (3.13%) than in the control group (21.88%, P < .05).Early breast-conserving surgery is more advantageous for breast cancers and results to lesser bleeding, rapid recovery, and fewer complications.
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Affiliation(s)
| | - Wen-Hui Xu
- Gastrointestinal Surgery Department, The Second Clinical Medical College, Yangtze University, Jingzhou, China
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