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Category: Volume 05 Issue 08 August 2017
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Title: Unilateral Subarachnoid Block for Surgeries in Neoplastic Breast Diseases- A Novel Trend

Authors: Dr S D Yannawar, Dr Sarfaraz Ahmed, Dr R G Pathak, Dr N K Nandanwankar,  Dr Nazima Memon

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.118

Abstract

Background: Carcinoma breast is the most common malignancy in Indian women which has recently overtaken cervical carcinoma as leading cause of cancer related morbidity and mortality. In India the incidence of carcinoma breast had been traditionally lower than in developed world. Some of this low incidence may have been due to lack of screening programs but lifestyle, reproductive and dietary factors also had a favorable outcome on low incidence. But this scenario is fast changing and along with change in life style in developing countries, awareness in general public and availability of equipments to detect the disease at peripheral health centers may be the reasons for increase in the incidence of carcinoma breast. Surgeries for carcinoma breast like simple or radical mastectomy are usually done under general anaesthesia. Spinal anaesthesia for mastectomies appears to be a promising new trend having advantage of decreased morbidity, less complications and early recovery.

Aims and Objectives: (1) To evaluate utility of unilateral subarachnoid block for surgeries for carcinoma breast and to study amount of analgesic and anesthetic drug if required. (2) To study complications associated with subarachnoid block in surgeries for carcinoma breast.

Materials and Methods: This was a prospective study conducted at a medical college in an urban area. Patients who had undergone surgeries for neoplastic breast diseases (carcinoma, breast phyllodes tumor) under unilateral subarachnoid were included in the study after considering inclusion and exclusion criteria of the study. Age, sex, weight, any associated co-morbidity and ASA status of the patients were recorded. For subarachnoid block inj. bupivacaine (0.5%) 2.8 ml with 0.2ml (60mcg) inj. buprinorphine were used. Events during surgery, hemodynamic stability and complications were studied.

Results: Total 90 patients were given unilateral subarachnoid block for their respective neoplastic breast diseases. 8 patients required conversion to general anaesthesia hence were excluded from the study. Out of 82 cases 47 cases were of simple mastectomy and 35 were of Modified radical mastectomy with Axillary dissection .Out of these 35 cases 15 cases required IV sedation. Out of 47 simple mastectomy cases none required additional analgesia. Inj.mephentermine for hypotension and inj Atropine for bradycardia had to be used in 35 and 3 patients respectively. No patient required intubation. Recovery was excellent in all the cases.

Conclusion: Unilateral subarachnoid block is a novel method of anaesthesia during surgeries for breast tumours. It is relatively safe and associated with good muscle relaxation and less blood loss.

Keywords: unilateral subarachnoid block, Carcinoma Breast, Complications and Outcome.

References

  1. Shulman LN, Willett W, Sievers A, Knaul FM. Breast Cancer in Developing Countries: Opportunities for Improved Survival. Journal of Oncology. 2010;2010:595167.
  2. Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol. 2017 Aug;13(4):289-295.
  3. Bloom HJG, Richardson WW. Histological Grading and Prognosis in Breast Cancer: A Study of 1409 Cases of which 359 have been Followed for 15 Years. British Journal of Cancer. 1957;11(3):359-377.
  4. Gürdal SÖ, Saraçoğlu GV, Oran EŞ, Yankol Y, Soybir GR. The effects of educational level on breast cancer awareness: a cross-sectional study in Turkey.Asian Pac J Cancer Prev. 2012;13(1):295-300.
  5. Bleyer A, Baines C, Miller AB. Impact of screening mammography on breast cancer mortality. Int J Cancer. 2016 Apr 15;138(8):2003-12.
  6. Fajdic J, Djurovic D, Gotovac N, Hrgovic Z. Criteria and Procedures for Breast Conserving Surgery. Acta Informatica Medica. 2013;21(1):16-19.
  7. Singh P, Kumar A, Trikha A. Rural perspective about anesthesia and anesthesiologist: A cross-sectional study. Journal of Anaesthesiology, Clinical Pharmacology. 2013;29(2):228-234.
  8. Ahmed Abdelaal Ahmed Mahmoud, Hazem Abdelwahab Hussein, Karim Girgis, Ahmed Mostafa Kamal, The novel use of spinal anesthesia at the mid-thoracic level: a feasibility study Egypt J Cardiothor Anesth, 8 (2014), pp. 21-26.
  9. Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anesthesia improves outcome after breast surgery. Annals of Surgery. 1995;222(5):663-669.
  10. Fassoulaki A. Brachial plexus block for pain relief after modified radical mastectomy. Anesth Analg. 1982 Dec;61(12):986–987.
  11. Dennison AR, Watkins RM, Ward ME, Lee EC. Simple mastectomy under local anaesthesia. Ann R Coll Surg Engl. 1985 Jul;67(4):243–244.
  12. Fodale V, D’Arrigo MG, Triolo S, Mondello S, La Torre D. Anesthetic Techniques and Cancer Recurrence after Surgery. The Scientific World Journal. 2014;2014:328513
  13. Divatia JV, Ambulkar R. Anesthesia and cancer recurrence: What is the evidence? Journal of Anaesthesiology, Clinical Pharmacology. 2014;30(2):147-150. doi:10.4103/0970-9185.129990.
  14. Lin L, Liu C, Tan H, Ouyang H, Zhang Y, Zeng W. Anaesthetic technique may affect prognosis for ovarian serous adenocarcinoma: A retrospective analysis. Br J Anaesth. 2011;106:814–22.
  15. Das J, Kumar S, Khanna S, Mehta Y. Are we causing the recurrence-impact of perioperative period on long-term cancer prognosis: Review of current evidence and practice. Journal of Anaesthesiology, Clinical Pharmacology. 2014;30(2):153-159.
  16. Ahmed Abdelaal Ahmed Mahmouda, Hazem Abdelwahab Husseina, Karim Girgisb, Ahmed Mostafa Kamalb, Hesham Ahmed Nafady ; The novel use of spinal anesthesia at the mid-thoracic level: a feasibility study .,Anesth Analg 2000; 90:1402–1405.
  17. Elakany MH, Abdelhamid SA. Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery. Anesthesia, Essays and Researches. 2013;7(3):390-395.
  18. Miyabe M, Namiki A. The effect of head-down tilt on arterial blood pressure after spinal anesthesia. Anesth Analg. 1993 Mar;76(3):549-52.
  19. Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carlsson PS. Thoracic paravertebral block for breast cancer surgery: A randomized double-blind study. Anesth Analg. 2007;105:1848–51.
  20. Salo M. Effects of anaesthesia and surgery on the immune response. ActaAnaest-hesiol Scand. 1992 Apr;36(3):201-20.

Corresponding Author

Dr Sarfaraz Ahmed

Assistant Professor, Dept of Anesthesia Dr Shankarrao Chavan Govt Medical College Nanded – India