Breast Cancer Clinical Trial
Official title:
Comparison Between Thoracic Para-vertebral Block and Segmental Thoracic Spinal Anesthesia in Breast Cancer Surgery
General anesthesia is the conventional technique used for breast surgery. breast surgery is associated with a high incidence of postoperative pain, it is estimated that over 50 % of women suffer chronic pain following breast cancer surgery. Regional anesthesia is a good alternative to general anesthesia for breast cancer surgery, providing superior analgesia and fewer side effects related to a standard opiate-based analgesia. there is no evident optimal regional techniques for operative procedures on the breast and axilla, like high thoracic epidural, cervical epidural, paravertebral block, intrerpleural block, PECs block, serratus plane block and segmental thoracic spinal anesthesia. Regional anesthesia decreases operative stress, provides beneficial hemodynamic effects especially for critically ill patients and decreases postoperative morbidity and mortality. Also it reduces post‑operative nausea and vomiting and provides prolonged post‑operative sensory block, minimizing narcotic requirements. Additionally, this application positively affects the early start of feeding and mobilization.
Thoracic paravertebral block (TPVB) is an alternative method to general anesthesia for
patients undergoing breast surgery, because it provides a safe anesthesia with balanced
hemodynamic response with unilateral somatic and sympathetic blockade, allows postoperative
analgesia lowering narcotic usage , minimal nausea and vomiting rate, early discharge and low
cost.
Segmental thoracic spinal anesthesia have introduced for cardiac surgery in adults and
children in the early 1990's. Kowalewski et al., performed over 10000 cases of spinal
injections without a single case of spinal/epidural hematoma or any neurological
complications, also segmental thoracic spinal anesthesia has been used successfully for
laparoscopic cholecystectomy and abdominal surgeries. It has some advantages when compared
with general anesthesia and can be a sole anesthetic in breast cancer surgery with axillary
lymph node clearance especially in critical cases. Among its advantages are the quality of
postoperative analgesia, lower incidence of nausea and vomiting, and shorter recovery time,
with the consequent early hospital discharge. The dose of the anesthetic is exceedingly low,
compared with lumbar spinal anesthesia, given the highly specific block to only certain nerve
functions along a section of the cord, there is no blockade of the lower extremities. This
means that a significantly larger portion of the body experiences no venal dilation, and may
offer a compensatory buffer to adverse changes in blood pressure intra-operatively. there was
no recorded of neurological complications.The incidence of parasthesia in a study with 300
patients subjected to thoracic spinal puncture at T10-11 was 4.67% in the cut needle group
and 8.67% in the pencil point needle group, similar to that reported in lumbar spinal
anesthesia.The aim of the present study is the comparison between two sole regional
anesthetic techniques, thoracic para-vertebral block and segmental thoracic spinal anesthesia
in breast cancer surgery especially for critically ill patients.
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