Local anaesthesia for breast cancer surgery

Anaesthetists using a regional technique can improve the quality and speed of recovery for breast cancer surgery patients, according to a new study.

The study, from researchers at St Michael’s Hospital and Women’s College Hospital, is the world’s first randomised control trial for breast cancer surgery that compares the use of ultrasound-guided paravertebral blocks to general anaesthetic. The findings reveal that breast cancer patients who received local anaesthetic had superior pain relief, spent less time in recovery rooms after surgery, and were discharged an hour earlier than patients who were put under general anesthesia.

“Real time, image-guided ultrasound nerve blocks have revolutionised the practice of regional anaesthesia,” said Dr Faraj Abdallah, anaesthetist and lead author of the study, published in Anesthesiology. “This is the first study to show how effective these ultrasound-guided blocks can now be for breast cancer surgery. Even more importantly, we’ve been able to demonstrate that blocks help patients feel better and return to their normal levels of mental and physical functionality sooner after surgery.”

Dr Abdallah conducted this randomised controlled trial of 64 women. The paravertebral block technique uses ultrasound to precisely guide a needle to intercostal nerves reaching the breast so it can deliver local anaesthetic to them. In total, five blocks are needed to freeze the five nerves involved, and surgeons can perform full or partial mastectomies, or even reconstructive breast surgery. At the same time, patients receive propofol sedation.

“There is a global interest in avoiding general anaesthesia in breast cancer surgery whenever possible because of potential long-term effects. Although effective, general anaesthesia use is also associated with nausea, vomiting and can result in excessive sedation even after surgery,” said Dr Tulin Cil, a study coauthor and general surgeon.

“Patients who receive general anaesthesia also require extra help to look after themselves in the first few days after surgery, whereas patients who received the nerve blocks are much more independent and require less support.”

“Without ultrasound it may take several attempts to administer the blocks,” said Dr Abdallah. “And even then, it would be difficult to tell if they’d hit their mark, so patients might feel pain during surgery and would then need to be put under general anaesthetic, which defeats the purpose.”

Dr Abdallah said that the benefits of paravertebral blocks following breast cancer surgery would also apply to cosmetic breast surgeries such as reductions or augmentation because the same breast nerves can be frozen in a similar manner.

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