Domenico P Santonastaso1, Annabella de Chiara1, Emanuele Russo1, Emiliano Gamberini1, Leonardo Lucchi2, Andrea Sibilio3, Claude Bagaphou4, Gianluca Zani5, Roberto Righetti5, Marco Rispoli6, Maurizio Fusari5, Vanni Agnoletti1. 1. Anaesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena (FC), Italy. 2. Day Surgery-Breast Unit, AUSL Romagna, M. Bufalini Hospital, Cesena (FC), Italy. 3. General Surgery Unit, AUSL Romagna, Santa Maria delle Croci Hospital, Ravenna, Italy. 4. Anaesthesia and Intensive Care Unit, USL Umbria 1 Ospedale di Città di Castello, Città di Castello (PG), Italy. 5. Anaesthesia and Intensive Care Unit, AUSL Romagna, Santa Maria delle Croci Hospital, Ravenna, Italy. 6. Anaesthesia and Intensive Care Unit, Vincenzo Monaldi Hospital, Napoli, Italy.
Abstract
INTRODUCTION: Quadrantectomy is a surgical procedure traditionally performed under general anaesthesia with intraoperative and postoperative opioid-based analgesia. The use of locoregional anaesthesia techniques in breast surgery has become widespread and allows excellent management of intraoperative and postoperative pain with reduced opioid consumption. We chose thoracic paravertebral block as regional anaesthesia technique in breast surgery to investigate the possibility of carrying out this surgery with the patient awake. METHODS: A prospective observational study on 50 patients was designed. The primary outcome for this study was the possibility to carry out the surgery with only the paravertebral block associated with mild sedation without general anaesthesia. Forty minutes before the start of the surgery, an ultrasound-guided thoracic paravertebral block was performed at two thoracic levels, and for each level, 7 mL of ropivacaine 0.7% was injected. Sedation was obtained with target-controlled infusion of propofol. RESULTS: Forty-nine patients underwent the operation awake; in one case, we had to place an I-gel and perform general anaesthesia. No patient needed intraoperative or postoperative opioids. The numeric rating scale, recorded at 0, 2, 6, 12, 24, and 36 hours, was greater than 3 in only five patients. CONCLUSIONS: We believe that if in the future we try to make quadrantectomy an intervention in which the anaesthesia is exclusively regional, therefore with a patient awake and collaborating, it will not be possible to ignore the use of thoracic paravertebral block.
INTRODUCTION: Quadrantectomy is a surgical procedure traditionally performed under general anaesthesia with intraoperative and postoperative opioid-based analgesia. The use of locoregional anaesthesia techniques in breast surgery has become widespread and allows excellent management of intraoperative and postoperative pain with reduced opioid consumption. We chose thoracic paravertebral block as regional anaesthesia technique in breast surgery to investigate the possibility of carrying out this surgery with the patient awake. METHODS: A prospective observational study on 50 patients was designed. The primary outcome for this study was the possibility to carry out the surgery with only the paravertebral block associated with mild sedation without general anaesthesia. Forty minutes before the start of the surgery, an ultrasound-guided thoracic paravertebral block was performed at two thoracic levels, and for each level, 7 mL of ropivacaine 0.7% was injected. Sedation was obtained with target-controlled infusion of propofol. RESULTS: Forty-nine patients underwent the operation awake; in one case, we had to place an I-gel and perform general anaesthesia. No patient needed intraoperative or postoperative opioids. The numeric rating scale, recorded at 0, 2, 6, 12, 24, and 36 hours, was greater than 3 in only five patients. CONCLUSIONS: We believe that if in the future we try to make quadrantectomy an intervention in which the anaesthesia is exclusively regional, therefore with a patient awake and collaborating, it will not be possible to ignore the use of thoracic paravertebral block.
Authors: Oreste Claudio Buonomo; Danilo Vinci; Gerardo De Carolis; Marco Pellicciaro; Francesco Petracca; Amir Sadri; Chiara Buonomo; Mario Dauri; Gianluca Vanni Journal: Front Surg Date: 2022-01-25