scholarly journals National Multidisciplinary Survey of Regional Anesthesia Preferences in Breast Reconstruction

2020 ◽  
Vol 28 (2) ◽  
pp. 105-111
Author(s):  
Linden K. Head ◽  
Anne Lui ◽  
Erin Cordeiro ◽  
Kirsty U. Boyd
Keyword(s):  
Breast Reconstruction ◽  
Regional Anesthesia ◽  
Primary Outcome ◽  
Response Rate ◽  
Intercostal Nerve ◽  
Autologous Reconstruction ◽  
Nerve Blocks ◽  
Pectoral Nerve ◽  
A Prospective Study ◽  
Alloplastic Reconstruction

Background: The purpose of this work was to determine the regional anesthesia preferences of plastic surgeons (PS) and anesthesiologists (A) involved in breast reconstruction in Canada. Methods: Online surveys were sent to members of the Canadian Society of Plastic Surgeons (CSPS) and the Canadian Anesthesiologists Society (CAS). The primary outcome was regional anesthesia preferences in breast reconstruction (delayed, immediate, alloplastic, autologous). Secondary outcomes included the availability and the influence of specialty and academic status on preferences. Statistical analysis used descriptive statistics and Pearson χ2 test. Results: Responses from CSPS and CAS totaled 141 (response rate = 30%) and 217 (response rate = 14%), respectively. Compared with non-academic centres (NAC), academic centres (AC) had significantly greater access to (AC = 60%, NAC = 39%, P = .001) and preferred to use regional anesthesia more often (AC = 36%, NAC = 10%, P < .001). The following proportions of physicians preferred to use regional anesthesia: 40% (PS = 32%, A = 44%, P = .081) for immediate alloplastic reconstruction, 23% (PS = 24%, A = 22%, P = .821) for delayed alloplastic reconstruction, 34% (PS = 18%, A = 41%, P < .001) for immediate autologous reconstruction, and 19% (PS = 13%, A = 21%, P = .195) for delayed autologous reconstruction. Regional anesthesia preferences were significantly different between plastic surgeons and anesthesiologists ( P < .001)—anesthesiologists favoured paravertebral blocks for all reconstructions, while plastic surgeons favoured pectoral nerve blocks for immediate alloplastic reconstruction and intercostal nerve blocks for all other reconstructions. Conclusions: Plastic surgeons and anesthesiologists prefer not to use regional anesthesia in the majority breast reconstructions. Among those who deploy regional anesthesia, plastic surgeons and anesthesiologist have divergent preferences with respect to modality. There is a need for a prospective study comparing paravertebral blocks and intercostal nerve blocks.

scholarly journals Intraoperative Intercostal Nerve Block for Postoperative Pain Control in Pre-Pectoral versus Subpectoral Direct-To-Implant Breast Reconstruction: A Retrospective Study

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 325 ◽  
Author(s):  
Jin-Woo Park ◽  
Jeong Hoon Kim ◽  
Kyong-Je Woo
Keyword(s):  
Postoperative Pain ◽  
Breast Reconstruction ◽  
Intercostal Nerve ◽  
Control Group ◽  
Intercostal Nerve Block ◽  
Nerve Blocks ◽  
Vas Score ◽  
Vas Scores ◽  
Lower Maximum ◽  
And Control

Background and Objectives: Patients undergoing mastectomy and implant-based breast reconstruction have significant acute postsurgical pain. The purpose of this study was to examine the efficacy of intercostal nerve blocks (ICNBs) for reducing pain after direct-to-implant (DTI) breast reconstruction. Materials and Methods: Between January 2019 and March 2020, patients who underwent immediate DTI breast reconstruction were included in this study. The patients were divided into the ICNB or control group. In the ICNB group, 4 cc of 0.2% ropivacaine was injected intraoperatively to the second, third, fourth, and fifth intercostal spaces just before implant insertion. The daily average and maximum visual analogue scale (VAS) scores were recorded by the patient from operative day to postoperative day (POD) seven. Pain scores were compared between the ICNB and control groups and analyzed according to the insertion plane of implants. Results: A total of 67 patients with a mean age of 47.9 years were included; 31 patients received ICNBs and 36 patients did not receive ICNBs. There were no complications related to ICNBs reported. The ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 6, p = 0.047), lower maximum VAS scores on the operative day (5 versus 7.5, p = 0.030), and POD 1 (4 versus 6, p = 0.030) as compared with the control group. Among patients who underwent subpectoral reconstruction, the ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 7, p = 0.005), lower maximum VAS scores on the operative day (4.5 versus 8, p = 0.004), and POD 1 (4 versus 6, p = 0.009), whereas no significant differences were observed among those who underwent pre-pectoral reconstruction. Conclusions: Intraoperative ICNBs can effectively reduce immediate postoperative pain in subpectoral DTI breast reconstruction; however, it may not be effective in pre-pectoral DTI reconstruction.

scholarly journals Anesthetic Substitute of Intraoperative Regional Anesthesia of Nonintubated or Endotracheal-intubated Video-assisted Thoracoscopic Surgery With Thoracoscopic Multilevel Intercostal Nerve Blocks: a Randomized Study

2021 ◽  
Author(s):  
Kuang-Cheng Chan ◽  
Li-Lin Wu ◽  
Su-Chuan Han ◽  
Jin-Shing Chen ◽  
Ya-Jung Cheng
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Surgical Stress ◽  
Thoracoscopic Surgery ◽  
Intercostal Nerve ◽  
General Anesthetics ◽  
Nerve Blocks ◽  
Video Assisted ◽  
First Case ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background:A reduced need for general anesthetics and enhanced effectiveness of postoperative analgesia have been reported for multimodal anesthesia, which involves combining regional and general anesthesia. Ideal regional anesthesia to combine with general anesthesia should match but not overdo with the surgical stress from corresponding operations. However, as thoracic operation becomes less invasive, the substitute effects on intraoperative analgesia or consciousness by regional anesthesia such as with thoracoscopic intercostal nerve blocks (TINBs) for managing corresponding surgical stress in intubated or non-intubated video-assisted thoracoscopic surgery (VATS) have been inadequately studied. The goals of this study is to investigate the substituve of TINBs on analgesia and consciousness for intubated and non-intubated uniport VATS operations.Methods:Sixty patients who received VATS with target-controlled infusions of propofol and remifentanil were recruited. Patients were randomized into intubated and nonintubated groups. Intraoperative multilevel (T3–T8) TINBs were performed after artificial pneumothorax and before VATS operations. The effects of substitute on analgesia by TINBs for VATS operations were indicated by changes on blood pressure and the Ce of remifentanil to maintain normotension. EEG data with a density spectral array (DSA) and data on the effect-site concentration (Ce) of propofol goaled with bispectral index (BIS) levels between 40-60were compared to determine whether TINBs affect consciousness. Results:TINBs with 0.5% bupivacaine provide substitute more than required on analgesia for intubated and non-intubated uniport VATS operations. The Ce of remifentanil was significantly decreased beginning 10 min after TINBs in both groups (p < 0.001). In the nonintubated VATS (NIVATS) group, a significantly lower mean arterial pressure after introducing TINBs persisted for 20 min. TINBs demonstrated a DSA smoothing effect despite the subsequent VATS. The Ce of the propofol infusion decreased 5 min after TINBs in both NIVATS (p < 0.001) and intubated VATS (IVATS; p = 0.252) groups. The Ce of remifentanil was significantly higher in parallel for the IVATS group than for the NIVATS group (p < 0.001).Conclusions:Intraoperative TINBs with 0.5 % bupivacaine provides substitutes on analgesia and hyponosis more than required for uniportal intubated or non-intubated VATS operations. Situations involving endotracheal tubes required more analgesia but does not affect the substitute effects of TINBs.Trial registration: ClinicalTrials. gov, NCT03874403. This study was approved by the Research Ethics Committee of National Taiwan University Hospital, Taipei, Taiwan (201712125RINB) on February 2, 2018. We then enrolled our first case on November 1, 2018 - Retrospective registered on February 28, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874403

scholarly journals Technique of Breast Reconstruction with Expander Implants after Mastectomy

2018 ◽  
Vol 1 (1) ◽  
pp. 82-88
Author(s):  
S Krämer ◽  
Friedrich M ◽  
Kraft C
Keyword(s):  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Radical Mastectomy ◽  
High Rate ◽  
Adjuvant Radiation ◽  
Autologous Reconstruction ◽  
Female Breast ◽  
Implant Reconstruction ◽  
Methods Of Reconstruction ◽  
Alloplastic Reconstruction

The reconstruction of the female breast after mastectomy is an integral part of the surgical treatment of breast cancer nowadays. If it is necessary for oncologic reasons and if there are contraindications for breast conserving therapy, methods of breast reconstruction can contribute significantly to the restoration of physical integrity, including an improvement of life quality for the affected women. Besides an improvement or restoration of the physical image and of the self-esteem, breast reconstruction leads to a processing of an oncologically necessary mastectomy from a psychooncological and rehabilitative point of view. Alloplastic methods of breast reconstruction are the most common methods of reconstructing the female breast after mastectomy. In order to obtain optimal results from reconstruction, the use of textured, anatomically shaped expander-implant systems are recommended. After modified radical mastectomy a combined expander implant reconstruction can be indicated to reconstruct a smaller, non-ptotic breast after preforming stretching of the skin. This combined expander-implant reconstruction can be performed primarily during mastectomy as well as secondarily. If adjuvant therapy is necessary, especially in the case of radiation therapy, an implant or expander-implant reconstruction is relatively contraindicated because of an insufficiently high rate of complication. The patients need to be informed about the very often necessity of adapting mastopexy or reduction mastopexy of the contralateral breast and about possible autologous methods of reconstruction. In our opinion, adjuvant radiation therapy is a contraindication for alloplastic reconstruction because of an inacceptable complication rate, especially if compared to autologous reconstruction. Therefore, primary alloplastic reconstruction should be indicated very critically. When planning alloplastic or, of course, autologous breast reconstruction the overall oncological situation of the patient needs to be considered. To avoid prognostic or aesthetic disadvantages, the differential indication for the methods of breast reconstruction should ideally take place in specialized breast centres with experience in all methods of reconstruction.

scholarly journals Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ariel Clare Johnson ◽  
Salih Colakoglu ◽  
Angela Reddy ◽  
Clara Marie Kerwin ◽  
Roland A Flores ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Enhanced Recovery ◽  
Anesthetic Technique ◽  
Single Shot ◽  
Nerve Blocks ◽  
Reconstruction Surgery ◽  
Opioid Medications

Context: High rates of mortality and chemical dependence occur following the overuse of narcotic medications, and the prescription of these medications has become a central discussion in health care. Efforts to curtail opioid prescribing include Enhanced Recovery After Surgery (ERAS) guidelines, which describe local anesthesia techniques to decrease or eliminate the need for opioids when used in a comprehensive protocol. Here, we review effective perioperative blocks for the decreased use of opioid medications post-breast reconstruction surgery. Evidence Acquisition: A comprehensive review was conducted using keywords narcotics, opioid, surgery, breast reconstruction, pain pump, nerve block, regional anesthesia, and analgesia. Papers that described a local anesthetic option for breast reconstruction for decreasing postoperative narcotic consumption, written in English, were included. Results: A total of 52 papers were included in this review. Local anesthetic options included single-shot nerve blocks, nerve block catheters, and local and regional anesthesia. Most papers reported equal or even superior pain control with decreased nausea and vomiting, length of hospital stay, and other outcomes. Conclusions: Though opioid medications are currently the gold standard medication for pain management following surgery, strategies to decrease the dose or number of opioids prescribed may lead to better patient outcomes. The use of a local anesthetic technique has been shown to reduce narcotic use and improve patients’ pain scores after breast reconstruction surgery.

scholarly journals Tissue Expansion: Further Attempts to Improve Results in Breast Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-7
Author(s):  
Donald A. Hudson ◽  
Kevin G. Adams ◽  
Saleigh Adams
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Simple Method ◽  
Second Stage ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Mean Size ◽  
The Mean ◽  
A Prospective Study

Tissue expansion, is a simple method of breast reconstruction. Method. A prospective study of 27 patients treated over a 43 month period is described. At the first stage the expander is inserted in the dual plane, and the medial pectoral nerve is divided. The tissue expander is over-expanded. Second stage: a de-epithelialized vertical triangle is used to aid anterior projection, an inframammary fold is created and a silicone gel prosthesis inserted. Z-plasties are added to the transverse scar. The contralateral breast can be treated or left alone. Complications were recorded and the results were assessed by 4 plastic surgeons using a visual analogue scale. Results. 19 patients had expanders inserted at mastectomy (2 bilateral) and 8 underwent delayed reconstruction, with a mean age of 47 years (range 30–65 years). A single prosthesis was inserted in 15 patients (mean size 320 mL) and two prosthesis were stacked in 12 patients (mean volume of 400 mL). The mean delay from full expansion to the second stage was 10 weeks (range 3 weeks–11 months). A contralateral augmentation was performed in 5 patients, pexy in 10, a reduction in 2 and in 8 patients no procedure was performed. One patient required explantation. The mean visual analogue assessment was 7. Conclusion. This technique should be considered enhance the cosmetic results in tissue expansion.

scholarly journals Combined transverse thoracis plane and pectoral nerve blocks for breast surgery under sedation

2021 ◽  
Vol 9 (1) ◽  
pp. 28-31
Author(s):  
E. J. Helmich ◽  
R. J. Van Den Broek ◽  
J. G. Bloemen
Keyword(s):  
Breast Surgery ◽  
Nerve Blocks ◽  
Pectoral Nerve

Breast Reconstruction Completion in the Obese: Does Reconstruction Technique Make a Difference in Its Achievement?

2021 ◽  
Author(s):  
Christine Velazquez ◽  
Robert C. Siska ◽  
Ivo A. Pestana
Keyword(s):  
Breast Reconstruction ◽  
Perioperative Complications ◽  
Major Complication ◽  
Normal Body Mass Index ◽  
Reconstruction Technique ◽  
Autologous Reconstruction ◽  
Obese Women ◽  
Areolar Complex ◽  
Obese Female ◽  
Increased Risk

Abstract Background Breast mound and nipple creation are the goals of the reconstructive process. Unlike in normal body mass index (BMI) women, breast reconstruction in the obese is associated with increased risk of perioperative complications. Our aim was to determine if reconstruction technique and the incidence of perioperative complications affect the achievement of reconstruction completion in the obese female. Methods Consecutive obese women (BMI ≥30) who underwent mastectomy and implant or autologous reconstruction were evaluated for the completion of breast reconstruction. Results Two hundred twenty-five women with 352 reconstructions were included. Seventy-four women underwent 111 autologous reconstructions and 151 women underwent 241 implant-based reconstructions. Chemotherapy, radiation, and delayed reconstruction timing was more common in the autologous patients. Major perioperative complications (requiring hospital readmission or unplanned surgery) occurred more frequently in the implant group (p ≤ 0.0001). Breast mounds were completed in >98% of autologous cases compared with 76% of implant cases (p ≤ 0.001). Nipple areolar complex (NAC) creation was completed in 57% of autologous patients and 33% of implant patients (p = 0.0009). The rate of successfully completing the breast mound and the NAC was higher in the autologous patient group (Mound odds ratio or OR 3.32, 95% confidence interval or CI 1.36–5.28 and NAC OR 2.7, 95% CI 1.50–4.69). Conclusion Occurrence of a major complication in the implant group decreased the rate of reconstruction completion. Obese women who undergo autologous breast reconstruction are more likely to achieve breast reconstruction completion when compared with obese women who undergo implant-based breast reconstruction.

scholarly journals Efficacy and safety of Si-Jun-Zi-Tang-based therapies for functional (non-ulcer) dyspepsia: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yaping Wang ◽  
Bin Liu ◽  
Xiuqiong Fu ◽  
Tiejun Tong ◽  
Zhiling Yu
Keyword(s):  
Relapse Rate ◽  
Large Scale ◽  
Primary Outcome ◽  
Response Rate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Efficacy And Safety ◽  
History Of ◽  
Non Ulcer Dyspepsia

Abstract Background The traditional Chinese medicine formula Si-Jun-Zi-Tang (SJZT) has a long history of application in the treatment of functional dyspepsia (non-ulcer dyspepsia, FD)-like symptoms. SJZT-based therapies have been claimed to be beneficial in managing FD. This study aimed to assess the efficacy and safety of SJZT-based therapies in treating FD by meta-analysis. Methods Systematic searches for RCTs were conducted in seven databases (up to February 2019) without language restrictions. Data were analyzed using Cochrane RevMan software version 5.3.0 and Stata software version 13.1, and reported as relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs). The primary outcome was response rate and the secondary outcomes were gastric emptying, quality of life, adverse effects and relapse rate. The quality of evidence was evaluated according to criteria from the Cochrane risk of bias. Results A total of 341 potentially relevant publications were identified, and 12 RCTs were eligible for inclusion. For the response rate, there was a statically significant benefit in favor of SJZT-based therapies (RR = 1.23; 95% CI 1.17 to 1.30). However, the benefit was limited to modified SJZT (MSJZT). The relapse rate of FD patients received SJZT-based therapies was lower than that of patients who received conventional medicines (OR = 0.23; 95% CI 0.10 to 0.51). No SJZT-based therapies-related adverse effect was reported. Conclusion SJZT-based prescriptions may be effective in treating FD and no serious side-effects were identified, but the effect on response rate appeared to be limited to MSJZT. The results should be interpreted with caution as all the included studies were considered at a high risk of bias. Standardized, large-scale and strictly designed RCTs are needed to further validate the benefits of SJZT-based therapies for FD management. Trial registration Systematic review registration: [PROSPERO registration: CRD42019139136].

scholarly journals Lactobacillus Kefiri LKF01 (Kefibios®) for Prevention of Diarrhoea in Cancer Patients Treated with Chemotherapy: A Prospective Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 385
Author(s):  
Michele Ghidini ◽  
Mariaceleste Nicoletti ◽  
Margherita Ratti ◽  
Gianluca Tomasello ◽  
Veronica Lonati ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Final Analysis ◽  
Clinical Effectiveness ◽  
High Grade ◽  
Combination Therapies ◽  
Grade 3 ◽  
Lactobacillus Kefiri ◽  
A Prospective Study

Diarrhoea is one of the main side effects that cancer patients face. The literature showsthat the incidence of chemotherapy (CT)-induced diarrhoea (grade 3–4) in treated patients is in the range of 10–20%, particularly after 5-fluorouracil (5-FU) bolus or some combination therapies of irinotecan and fluoropyrimidines. The aim of the present study was to evaluate the clinical effectiveness of Lactobacillus kefiri LKF01 (Kefibios®) in the prevention or treatment of CT-related diarrhoea in the cancer population. We conducted a prospective observational study. Patients enrolled were adults treated for at least four months with 5-FU-based CT. Kefibios® was administered to patients every day. The primary outcome was the evaluation of the incidence of grade 3–4 CT-induced diarrhoea. We included 76 patients in the final analysis. A 6.6% incidence of high-grade diarrhoea was found in the evaluated population (4.7% of patients treated with 5-FU-based therapy and 8.5% of patients treated with capecitabine-based CT). The overall incidence of high-grade diarrhoea observed was higher in the 1st and 2nd cycles (3.9%), with a subsequent sharp reduction from the 3rd cycle (1.3%) and negativisation from the 5th cycle. Lactobacillus kefiri LKF01 (Kefibios®) is safe and effective in preventing severe diarrhoea in cancer patients receiving 5-FU or capecitabine-based treatment.

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