ABSTRACT
OBJECTIVE: To evaluate superficial serratus anterior plane block's efficacy and side effects in preventing postoperative pain after breast cancer surgery. METHODOLOGY: A prospective cohort study was conducted on 195 adult patients undergoing breast oncological surgery under general anesthesia (Group G, n = 96) or combined general anesthesia with superficial serratus anterior plane block (Group L, n = 99). Validated preoperative data, which are predictors of chronic postoperative pain of patients, were recorded (type of surgery, age, pain in the area of the intervention and the other regions; anesthetic-surgical data, analgesic doses used, duration of surgery; pain intensity (EVN scale) at immediate postoperative period, 24 h, seven days and one month after the surgery, and complications. RESULTS: Pain intensity, measured by the EVN scale, had a mean of 1.02 +/- 1.656 in the Postoperative Unit; 1.20 +/- 1.448 at 24 h; 0.76 +/- 1208 seven days; and 0.34 +/- 0.757 one month after surgery. Patients were operated under general anesthesia (n = 96) or general anesthesia combined with the interfascial block (n = 99). Significant differences (p < 0.05) were found in age, height, and VAS scale in PACU. Ten complications were recorded, six in Group L and four in Group G. There were no differences between groups in complications. CONCLUSIONS: Superficial serratus anterior plane blocks are effective and safe in pain control in the immediate postoperative period for breast cancer surgery as a part of the multimodal approach. No significant differences were found one week and one month after surgery.
Subject(s)
Breast Neoplasms , Pain, Postoperative , Adult , Humans , Female , Cohort Studies , Prospective Studies , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Breast Neoplasms/surgery , Breast Neoplasms/complications , Ultrasonography, InterventionalABSTRACT
Introduction: Historically, pathological and laboratory factors are considered in the prognosis of breast cancer. Tumor resection surgery constitutes the main treatment, but paradoxically, the surgical manipulation and perioperative immunosuppression may predispose to cancer dissemination. Locoregional anesthetic techniques would avoid this immunosuppression, thus improving the oncologic outcomes of surgery. This study aimed to evaluate the prognostic influence of locoregional anesthesia on breast cancer dissemination and recurrence after surgery. Methods: A retrospective cohort study was performed on 165 centrolobulillar breast cancer patients, scheduled for non-reconstructive breast oncologic surgery between 2012 and 2015. These patients were treated with conservative surgery under general anesthesia (control group, n = 81) or combined anesthesia with a locoregional block (n = 84). Data were collected on age, tumor type (size, stage, lymph node infiltration), immunohistochemical factors (hormone receptors), procedure (duration, technique), anesthesia (general anesthesia or associated with regional blockade), complications, survival, and recurrence. Results: Statistical analysis demonstrated no significative differences in age, weight, sex, ASA status, and surgical technique and duration. Tumor recurrence was recorded in 6 patients (4 in the general group and 2 in the locoregional group) 1 year after surgery, and 6 (4 in the general group and 2 in the locoregional group) 5 years after. No significant differences between groups in morbi-mortality were found. Conclusions: Following the interfascial analgesic technique, a lower rate of tumor recurrence was observed, but no significant differences. (AU)
Introducción: Históricamente, se han considerado los factores patológicos y de laboratorio para pronosticar el cáncer de mama. La cirugía de resección tumoral constituye el tratamiento principal pero, paradójicamente, la manipulación quirúrgica y la inmunosupresión perioperatoria pueden predisponer a la diseminación del cáncer. Las técnicas anestésicas locorregionales evitarían esta inmunosupresión, mejorando por tanto los resultados oncológicos de la cirugía. El objetivo de este estudio fue evaluar la influencia pronóstica de la anestesia locorregional en la diseminación y recidiva del cáncer de mama tras la cirugía. Métodos: Se realizó un estudio de cohorte retrospectivo de 165 pacientes de cáncer de mama centrolobulillar, programadas para cirugía oncológica de mama no reconstructiva entre 2012 y 2015. Dichas pacientes fueron tratadas con cirugía conservadora bajo anestesia general (grupo control, n = 81) o anestesia combinada con bloqueo locorregional (n = 84). Se recopilaron datos sobre edad, tipo de tumor (tamaño, estado, infiltración ganglionar), factores inmunohistoquímicos (receptores hormonales), procedimiento (duración, técnica), anestesia (anestesia general o anestesia asociada a bloqueo regional), complicaciones, supervivencia y recidiva. Resultados: El análisis estadístico no mostró diferencias significativas en cuando a edad, peso, sexo, estatus ASA, técnica quirúrgica y duración. Se registró la recidiva tumoral en 6 pacientes (4 en el grupo general y 2 en el grupo locorregional) transcurrido un año de la cirugía, y 6 pacientes (4 en el grupo general y 2 en el grupo locorregional) transcurridos cinco años. No se encontraron diferencias significativas entre los grupos en términos de morbi-mortalidad. Conclusiones: Tras la técnica analgésica interfascial, se observó una tasa de recidiva tumoral inferior, aunque sin diferencias significativas. (AU)
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Breast Neoplasms/drug therapy , Breast Neoplasms/diagnosis , Anesthesia , Retrospective Studies , Cohort Studies , Breast Neoplasms/surgery , Breast Neoplasms/prevention & control , Secondary PreventionABSTRACT
El período perioperatorio es determinante en los resultados oncológicos tras la cirugía de mama, pues numerosos factores influyen en la función inmune, la angiogénesis y la diseminación tumoral. El objetivo de esta revisión fue identificar los factores de riesgo perioperatorios asociados con la proliferación y la recurrencia del cáncer tras la cirugía oncológica de mama, para ello se siguió el protocolo PRISMA (registro en PROSPERO con número CRD42021227297). Tras una búsqueda bibliográfica en PubMed, Google Scholar, Web of Science y Embase, guías clínicas europeas y Cochrane, se incluyeron estudios en inglés o español, que cumplieran criterios de calidad establecidos. Las variables cualitativas se presentaron según su distribución de frecuencias. Se analizaron 34 estudios de las 253 publicaciones identificadas, utilizando el programa estadístico IBM SPSS Statistics versión 24.0 para Windows. El tiempo de seguimiento fue de 36 meses de media (rango amplio entre 1 día y 5 años), encontrando 10% de recurrencias tumorales tras la cirugía de mama y mayor supervivencia libre de tumor no significativa en caso de anestesia intravenosa libre de opioides frente a anestesia inhalatoria con opioides. En general se encuentran mejores resultados oncológicos con antiinflamatorios, ketamina, bloqueantes del sistema nervioso simpático, anestésicos locales y buen control del dolor postoperatorio. Se necesitan ensayos clínicos multicéntricos que analicen los factores pronósticos oncológicos de forma independiente, con seguimiento superior a la supervivencia tumoral, que estudien los factores histológicos, anatomopatológicos y de extensión asociados a la agresividad oncológica. (AU)
Perioperative period is decisive in oncological results after breast surgery, because of numerous factors are involved in immune function, angiogenesis and tumor spread. The aim of this review was to identify perioperative risk factors associated with cancer proliferation and recurrence after breast cancer surgery. PRISMA protocol was followed for this purpose (PROSPERO registration number CRD42021227297). After bibliographic search in PubMed, Google Scholar, Web of Science and Embase, European clinical guidelines and Cochrane, we included studies in English or Spanish, which met established quality criteria. The qualitative variables were presented according to their frequency distribution. We analyzed 34 studies of the 253 identified publications, using the statistical program IBM SPSS Statistics version 24.0 for Windows. The follow-up time was 36 months on average (wide range between 1 day and 5 years), finding 10% tumor recurrences after breast surgery and increased tumor-free survival in case of opioid-free intravenous anesthesia versus inhalation anesthesia with opioids, but no significant differences were found. Recurrence data were better every time that anti-inflammatories, ketamine, sympathetic nervous system blockers and, local anesthetics were used and good postoperative pain control registered. There is a need for multicenter clinical trials that analyze oncological prognostic factors independently, with follow-up greater than tumor survival, and that study the histological, pathological and extension factors associated with oncological aggressiveness. (AU)
