Aim: Acute post-operative pain following modified radical mastectomy (MRM) in patients with breast cancer is challenging for anesthesiologists. This study aimed to prospectively compare the quality outcome of interfascial plane blocks performed with ultrasound guidance, and evaluate the consequences of sharing tasks with the breast surgeon. Patients and Methods: The study involved 255 patients scheduled for unilateral MRM, who were divided into two groups: Pecs group: General anesthesia plus ultrasound-guided modified pectoral nerves blocks type I and II, including serratus and parasternal infiltration according to surgical requirements; and Control group: general anesthesia only. Quality was evaluated based on perioperative opioid consumption, reported pain intensity, rescue analgesic requirement, side-effects and length of hospital stay. Moreover, a breast surgeon with expertise in ultrasound-guided breast biopsy was trained to perform the blocks. The patient benefits from regional anesthesia delivered by a non-anesthesiologist were assessed. Results: Significant reductions were noted in all of the following: Intraoperative opioid consumption (p<0.001), Numerating Rating Scale pain scores taken 0 and 24 h after surgery (p<0.001), post-operative analgesic administration (p<0.001), nausea and vomiting at 0, 6, and 12-h intervals (p<0.05), and hospital stay (p<0.001) were observed in the Pecs group compared with the control group. Furthermore, data obtained from patients receiving the block from the surgeon showed comparable benefits with no complications. Conclusion: Interfascial plane blocks may be an important alternative protocol in MRM, enhancing patient safety and cost benefits. Improvements in cross-disciplinary expertise through flexibility in the training of professionals with other backgrounds may provide effective analgesia and favorable outcomes.

Ultrasound-guided interfascial plane blocks for non-anesthesiologists in breast cancer surgery: functional outcomes and benefits / Grasso, A.; Orsaria, P.; Costa, F.; D'Avino, V.; Caredda, E.; Hazboun, A.; Carino, R.; Pascarella, G.; Altomare, M.; Buonomo, O. C.; Agro, F. E.; Altomare, V.. - In: ANTICANCER RESEARCH. - ISSN 0250-7005. - 40:4(2020), pp. 2231-2238. [10.21873/anticanres.14185]

Ultrasound-guided interfascial plane blocks for non-anesthesiologists in breast cancer surgery: functional outcomes and benefits

Orsaria P.
Secondo
;
Altomare M.
Conceptualization
;
2020

Abstract

Aim: Acute post-operative pain following modified radical mastectomy (MRM) in patients with breast cancer is challenging for anesthesiologists. This study aimed to prospectively compare the quality outcome of interfascial plane blocks performed with ultrasound guidance, and evaluate the consequences of sharing tasks with the breast surgeon. Patients and Methods: The study involved 255 patients scheduled for unilateral MRM, who were divided into two groups: Pecs group: General anesthesia plus ultrasound-guided modified pectoral nerves blocks type I and II, including serratus and parasternal infiltration according to surgical requirements; and Control group: general anesthesia only. Quality was evaluated based on perioperative opioid consumption, reported pain intensity, rescue analgesic requirement, side-effects and length of hospital stay. Moreover, a breast surgeon with expertise in ultrasound-guided breast biopsy was trained to perform the blocks. The patient benefits from regional anesthesia delivered by a non-anesthesiologist were assessed. Results: Significant reductions were noted in all of the following: Intraoperative opioid consumption (p<0.001), Numerating Rating Scale pain scores taken 0 and 24 h after surgery (p<0.001), post-operative analgesic administration (p<0.001), nausea and vomiting at 0, 6, and 12-h intervals (p<0.05), and hospital stay (p<0.001) were observed in the Pecs group compared with the control group. Furthermore, data obtained from patients receiving the block from the surgeon showed comparable benefits with no complications. Conclusion: Interfascial plane blocks may be an important alternative protocol in MRM, enhancing patient safety and cost benefits. Improvements in cross-disciplinary expertise through flexibility in the training of professionals with other backgrounds may provide effective analgesia and favorable outcomes.
2020
breast surgery; modified radical mastectomy; nonphysician anesthesia provider; pecs block; postoperative pain; regional anesthesia; adult; aged; anesthesia, general; anesthesiologists; breast; breast neoplasms; female; humans; mastectomy, modified radical; middle aged; nerve block; pain measurement; pain, postoperative; prospective studies; thoracic nerves; ultrasonography, interventional
01 Pubblicazione su rivista::01a Articolo in rivista
Ultrasound-guided interfascial plane blocks for non-anesthesiologists in breast cancer surgery: functional outcomes and benefits / Grasso, A.; Orsaria, P.; Costa, F.; D'Avino, V.; Caredda, E.; Hazboun, A.; Carino, R.; Pascarella, G.; Altomare, M.; Buonomo, O. C.; Agro, F. E.; Altomare, V.. - In: ANTICANCER RESEARCH. - ISSN 0250-7005. - 40:4(2020), pp. 2231-2238. [10.21873/anticanres.14185]
File allegati a questo prodotto
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1629631
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus 14
  • ???jsp.display-item.citation.isi??? 17
social impact