scholarly journals Anaesthesia Experience for Breast Surgery with Ultrasound-Guided Pecs Block II in High-Risk Elderly Patients - Two Case Reports

2021 ◽  
Vol 10 (10) ◽  
pp. 739-742
Author(s):  
Cengiz Kaya ◽  
Burhan Dost ◽  
Yasemin Burcu Ustun
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Elderly Patients ◽  
Breast Surgery ◽  
Case Reports ◽  
Intercostal Nerve ◽  
Anaesthetic Technique ◽  
Ultrasound Guided ◽  
Long Thoracic Nerve ◽  
Cancer Resection

The incidence of breast cancer has increased significantly over recent years.1 Surgery is the gold standard treatment for most cases, and general anaesthesia (GA) is the preferred anaesthetic technique. However, regional anaesthesia may be an alternative to GA in multimodal regimens in high-risk patients to avoid GA-related cardiovascular or pulmonary side effects.2 The use of neuraxial techniques [thoracic epidural or thoracic paravertebral block (TPVB)] or an intercostal nerve block can therefore be suggested.3 However, novel approaches that are easier, safer, and more effective have been proposed to overcome possible complications and difficulties of these techniques. One approach, the pectoral nerve (Pecs) II block, is a fascial plane block that has shown promising results in anterolateral chest wall 2 analgesia.3,4 The aim of this technique is to block the pectoral nerves, intercostobrachial, intercostals3- 6 and the long thoracic nerve.4 The Pecs block II has been used successfully as part of the multimodal regimen for postoperative analgesia, but not yet as a primary anaesthetic technique in breast surgery.3 Here, we describe breast cancer resection with ultrasound (US)-guided Pecs block II and sedation in two high-risk elderly patients. Both patients provided written consent for publication of the case reports and related images. Here, we present two breast cancer resection cases with multiple comorbidities who underwent ultrasound-guided Pecs II blocks under sedation. Additional analgesic and / or local anaesthetic infiltration was required for parasternal region pain (simple mastectomy, Case 1) and axillary region pain (sentinel node biopsy, Case 2). However, Pecs II blocks may not block the anterior cutaneous intercostal nerve branches or the intercostobrachial nerve in operations involving the medial part of the breast or extending to the axilla.

scholarly journals THE COMBINATION OF ULTRASOUND-GUIDED PECTORAL NERVES II AND PARASTERNAL BLOCKS AS A VALID ALTERNATIVE FOR ANESTHESIA IN BREAST SURGERY: AN OBSERVATIONAL STUDY

2017 ◽  
pp. 175-179
Author(s):  
Erika Basso Ricci
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
Observational Study ◽  
Breast Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Thoracic Wall ◽  
Lateral Part ◽  
Ultrasound Guided ◽  
Mastectomy Group

Background: Breast cancer surgery is often associated with severe postoperative pain that may compromise systemic homeostasis, which increases perioperative morbidity, the length of stay in the hospital, and costs. Scientifi c evidence has also shown that an inadequate analgesia could promote the risk of persistent pain development after breast surgery. Objective: Recent literature suggested that the pectoral nerves II (PECS II) block may represent a valid alternative to general anesthesia (GA) and conventional, regional techniques for analgesia in breast surgery. This technique may provide complete anesthesia of the lateral part of the thorax but cannot block, by itself, the anterior cutaneous branches of the intercostal nerves. The combination of a parasternal block (PSB) and a PECS II block has been performed as a single anesthetic technique. Study Design: This is an observational, monocenter, prospective, and cohort study. We obtained the approval of our scientifi c ethic committee and clinical trials registration. Setting: This study enrolled patients undergoing an elective breast surgery. In particular, we enrolled patients who were scheduled for a mastectomy or quadrantectomy of the medial part of the breast. Methods: We recruited 40 patients who were scheduled for breast surgery. A PECS II block was performed with an injection of ropivacaine 0.5% 20 mL + 10 mL. Then, a PSB was performed by 2 separate injections of 3 mL of 0.5% ropivacaine, for each one, at the level of the second and fourth intercostal space. All of the patients received intraoperative sedation and multimodal analgesia. During the intraoperative period, the accessory need of a local anesthetic infi ltration, conversion to GA, and the total amount of propofol required to maintain good comfort of the patients were recorded. In the fi rst 24 postoperative hours, every 6 hours, postoperative pain was assessed by an investigator using a numerical rating scale (NRS). The consumption of analgesic and antiemetic drugs and the incidence of postoperative nausea and vomiting (PONV) were also recorded. Results: Our observational analysis yielded 40 patients in a period of 6 months. The population was subdivided into 2 groups: a mastectomy group or a quadrantectomy group. All of the population reported their pain scores at rest (rNRS < 3) and during activity (iNRS < 5) in the postoperative period. None of the patients required GA. Six patients (27.3%) in the mastectomy group required a supplemental anesthetic infi ltration. Eleven (27.5%) patients required a rescue analgesic drug: 9 (40.9%) in the mastectomy group and 2 (11.1%) in the quadrantectomy group. Two patients reported events of PONV, one for each group (4.54% for the mastectomy group and 5.55% for the quadrantectomy group). No complications occurred. Conclusion: This study indicates the safety and feasibility of the novel ultrasound-guided thoracic wall blocks during inpatient and outpatient breast surgery for the management of intraoperative anesthesia and postoperative analgesia. Limitations: This is an observational study; a randomized control trial is mandatory to confi rm the results. Key words: Breast cancer surgery, pectoralis nerve block, parasternal block, ultrasound-guided anesthesia, regional anesthesia, pain control

Ultrasound-Assisted Tumor Surgery in Breast Cancer – A Prospective, Randomized, Single-Center Study (MAC 001)

2018 ◽  
Vol 40 (03) ◽  
pp. 326-332 ◽  
Author(s):  
Jürgen Hoffmann ◽  
Mario Marx ◽  
Andreas Hengstmann ◽  
Harald Seeger ◽  
Ernst Oberlechner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
Resection Margins ◽  
Wire Localization ◽  
Single Center ◽  
Ultrasound Guided ◽  
Guided Surgery ◽  
Duration Of Surgery ◽  
Ultrasound Assisted ◽  
Resection Volume

Abstract Purpose Breast-conserving therapy is associated with a risk of tumor-involved margins. For intraoperative orientation, non- palpable or indistinctly palpable lesions are wire-marked prior to surgery. Ultrasound-guided surgery has the potential to reduce the number of tumor-involved margins. In the MAC 001 trial we evaluated ultrasound-guided breast-conserving surgery compared to wire-guided surgery with regard to free tumor margins, duration of surgery and resection volume. Materials and Methods In this randomized, prospective, single-center controlled trial, patients with ductal invasive breast cancer were recruited for either ultrasound-guided or wire localization surgery. Primary outcomes were tumor-free resection margins, the reoperation rate and the resection volume in each group. The results were analyzed by intention to treat. The trial was registered under ClinicalTrials.gov NCT02222675. Results 56 patients were assessed, and 47 patients were evaluated in the trial. 93 % (25/27) of the patients in the ultrasound arm had an R0 reoperation compared to 65 % (13/20) in the wire localization control arm. This result was statistically significant (p = 0.026). No statistical difference was found for the resection volume or the duration of surgery between the two arms. No major complication was seen in either arm. Conclusion Ultrasound-assisted breast surgery significantly increases the possibility of tumor-free margins and therefore reduces the risk of reoperations. Breast surgeons should be trained in ultrasound and ultrasound should be available in every breast surgery operating room.

scholarly journals Long-Term Cardiac Safety and Survival Outcomes of Neoadjuvant Pegylated Liposomal Doxorubicin in Elderly Patients or Prone to Cardiotoxicity and Triple Negative Breast Cancer. Final Results of the Multicentre Phase II CAPRICE Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Miguel J. Gil-Gil ◽  
Meritxell Bellet ◽  
Milana Bergamino ◽  
Serafín Morales ◽  
Agustí Barnadas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Elderly Patients ◽  
Phase Ii ◽  
Liposomal Doxorubicin ◽  
Triple Negative ◽  
Pegylated Liposomal Doxorubicin ◽  
Left Ventricular Ejection ◽  
Cardiac Safety

BackgroundThe CAPRICE trial was designed to specifically evaluate neoadjuvant pegylated liposomal doxorubicin (PLD) in elderly patients or in those with other cardiovascular risk factors in whom conventional doxorubicin was contraindicated. The primary analysis of the study showed a pathological complete response (pCR) of 32% and no significant decreases in LVEF during chemotherapy. Here, we report important secondary study objectives: 5-year cardiac safety, disease-free survival (DFS), overall survival (OS) and breast cancer specific survival (BCSS).MethodsIn this multicentre, single-arm, phase II trial, elderly patients or those prone to cardiotoxicity and high risk stage II-IIIB breast cancer received PLD (35 mg/m2) plus cyclophosphamide (600 mg/m2) every 4 weeks for 4 cycles, followed by paclitaxel for 12 weeks as neoadjuvant chemotherapy (NAC). Left ventricular ejection fraction (LVEF) monitorization, electrocardiograms and cardiac questionnaires were performed at baseline, during treatment and at 9, 16, 28 and 40 weeks thereafter. The primary endpoint was pCR and 5-year cardiac safety, DFS, BCSS and OS were also analyzed.ResultsBetween Oct 2007, and Jun 2010, 50 eligible patients were included. Median age was 73 (35-84) years, 84% were older than 65; 64% of patients suffered from hypertension, and 10% had prior cardiac disease. Most of tumors (88%) were triple negative. No significant decreases in LVEF were observed. The mean baseline LVEF was 66.6% (52-86) and after a median follow-up of 5 years, mean LVEF was 66 (54.5-73). For intention to treat population, 5-year DFS was 50% (95% CI 40.2-68.1) and 5-year OS was 56% (95%CI 41.2-68.4). There were 8 non-cancer related deaths, achieving a 5 years BCSS of 67.74% (CI 95%:54.31%- 81.18%).ConclusionAt 5-year follow-up, this PLD-based NAC regimen continued to be cardiac-safe and effective in a population of very high-risk breast cancer patients. This scheme should be considered as an option in elderly patients or in those with other risks of developing cardiotoxicity.Trial Registration NumberClinicalTrials.gov reference NCT00563953.

Breast Cancer in the Elderly

2018 ◽  
Author(s):  
Catherine Pesce ◽  
Katharine Yao
Keyword(s):  
Breast Cancer ◽  
Life Expectancy ◽  
Elderly Patients ◽  
Neoadjuvant Therapy ◽  
Breast Surgery ◽  
Survival Rates ◽  
The Elderly ◽  
Breast Cancer Patients ◽  
Younger Women ◽  
Key Words Breast

Elderly patients with breast cancer are more likely to present with more favorable tumor characteristics and molecular subtypes; however, outcomes are worse, with lower survival rates compared with younger women. Less use of screening, undertreatment, the frequency of comorbidities, and the lack of information in clinical trials on the use of systemic therapy in this population all likely play a role. Unless patients have a prohibitive risk for surgery or a life expectancy less than 5 years, surgery should be considered for elderly patients who are surgically resectable. Radiation and chemotherapy are less likely to be used in elderly patients; however, with an increase in the use of neoadjuvant therapy for breast cancer patients, recommendations or guidelines for neoadjuvant therapy for the elderly are needed. Further tools that can assist physicians with risk assessment of elderly patients for both surgery and adjuvant therapies are needed. A multidisciplinary discussion that includes discussion of the need for adjuvant therapy is necessary and should be balanced against the patient’s comorbidities and functional status when deciding on the best course of treatment for these patients. It should be emphasized that elderly patients should be offered standard treatments that nonelderly patients receive, and these recommendations should only be modified if there is limited life expectancy or other socioeconomic factors that influence whether patients can undergo standard treatments. This review contains 2 figures, 11 tables, and 60 references Key words: breast surgery, breast cancer in the elderly, elderly breast surgery, elderly oncology, geriatric breast surgery

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