PVB given before surgery in combination with GA could provide better postoperative analgesia and better QoR than did GA alone in patients undergoing surgery for unilateral breast cancer.

IntroductionThe conventional approach during thoracoscopic esophagectomy was performed in the left lateral decubitus position (LLDP). Recently, thoracoscopic esophagectomy in the prone position (PP) has attracted the attention of surgeons.AimTo report institutional experience with thoracoscopic esophagectomy in PP and compare it with the conventional LLDP approach.Material and methodsWe reviewed 59 consecutive patients who had presented with esophageal cancer undergoing three-stage thoracoscopic/laparoscopic esophagectomy (TLE) from May 2011 to Dec 2013. The TLE was sequentially performed on enrolled patients in LLDP from May 2011 to Oct 2012 and in PP from Nov 2012 to Dec 2013. Immediate postoperative outcomes were collected and compared to determine differences between the 2 groups.ResultsThirty-eight patients had their operations in LLDP and 21 in PP. No differences in blood loss, respiratory condition during surgery, or postoperative pain scores were observed between the 2 groups. The PP had a shorter thoracic stage duration (3.4 vs. 3.9 h; p = 0.03) and shorter intensive care unit (ICU) stay (1.0 vs. 1.5 days; p = 0.03) but yielded a similar number of lymph nodes. Incidence of complications was similar between the 2 groups, except significantly lower incidence of pneumonia in PP (0% vs. 21.1%; p = 0.04) and higher incidence of hoarseness in PP (52.4% vs. 23.7%; p = 0.03). The symptoms resolved within 3 months in all patients except in the 2 patients with vocal cord palsy.ConclusionsIt is feasible and safe to perform thoracoscopic esophagectomy by adopting the prone position. Thoracoscopic esophagectomy in the prone position is potentially associated with fewer major complications and shorter ICU stay.

Background: Paravertebral block (PVB) was shown to reduce postoperative pain and postoperative nausea and vomiting for breast surgery. However, there is no evidence showing that these benefits were solely provided by PVB and positively influence patient-perceived outcomes after breast cancer surgery. Methods:One hundred breast cancer patients were randomized into three groups: general anesthesia (GA, n=34), GA with PVB (GA+ PVB, n=33), PVB with sedation (PVB, n=33). The quality of recovery (QoR) score was assessed preoperatively as baseline, 6 hours postoperatively, and on postoperative day (POD) 1. Analgesia effects, adverse events, and perioperative satisfactions were also assessed. Results:The rate of QoR 6 hours reaching 18 in GA group (25.53%) seemed to be lower compared with GA+PVB (30.3%) or PVB (42.42%) but without statistical significance. Nevertheless, multivariate logistic regression analysis demonstrated that modality of PVB affected QoR 6 hours (p=0.04). Analgesic consumptions and pain scores were significantly higher and time to first request of analgesics shorter in GA group. The incidences of the GA-related undesired effects were significantly lower and satisfaction with emergence significantly better (P < 0.0001) in PVB group when compared with GA group. There was no difference between GA and GA+PVB in these outcomes. Conclusions:Anesthesia modalities containing PVB provided better pain control. Anesthesia modalities avoiding GA, i.e. PVB alone, led to significantly lower incidences of GA-related adverse events, significantly better satisfaction with the process of emergence, and contribution to QoR 6hours reaching 18.