A randomised trial: effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy

Li, Jiacen; Liu, Qiang; Su, Wenjie; Li, Meiting; Du, Yu; Hu, Yunxia

doi:10.21037/gs-21-343

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Total postoperative PCA fentanyl consumption, especially the PCA press consumption, and the rate of postoperative flurbiprofen axetil requirement were all decreased by the TTP-PECS compared with TPVB. These results suggested TTP-PECS to be more effective as a postoperative analgesic technique than TPVB which was consistent with several retrospective studies (Zhang et al 2018 , Li et al 2021 ). Under real-time US guidance, with the deposition of local anesthetic drugs into the fascial planes, the TTP-PECS would be more accurate to provide higher analgesic efficacy for mastectomy and axillary clearance because of its complete paranesthesia of the hemithorax.…”

Section: Discussionsupporting

confidence: 90%

Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modified radical mastectomy: a comparison with the thoracic paravertebral nerve block

et al. 2022

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Background Modified radical mastectomy (MRM) is the most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain and even lasts for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM. Methods In this randomized controlled trial, eighty female breast cancer patients undergoing unilateral MRM with sentinel lymph node dissection (SLND) and axillary dissection (ALND) were enrolled. Patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n = 40) or TPVB (TPVB group, n = 40) with 0.5% ropivacaine 30 ml. Evaluated variables included 24 h postoperative total PCA fentanyl consumption, including PCA background consumption and PCA press consumption (per bolus dosage multiply by the effective pressing times), and intraoperative fentanyl consumption, as well as postoperative flurbiprofen axetil requirement, duration of analgesia, blocking area, pain intensity at rest and during activity, ability to reduce the inflammatory response, and the quality of recovery 40 (QoR-40) score of patients. Results Compared with the TPVB, the main blocking area was T2–T6 in the TTP-PECS group, which was more suitable for the MRM. TTP-PECS has a longer analgesia duration than TPVB; 24 h postoperative total PCA fentanyl consumption, especially the PCA press consumption, and the postoperative flurbiprofen axetil requirement were decreased in the TTP-PECS group than those in the TPVB group. Furthermore, the VAS scores at rest and during activity and inflammatory response were lower in the TTP-PECS group compared with the TPVB group at 12 h postoperatively. Finally, the total QoR-40 score, especially for the scores of pain; emotional state; and patient support were better in the TTP-PECS group. Conclusion Compared with the TPVB, TTP-PECS can provide better postoperative analgesia in patients undergoing MRM, simultaneously reduce the inflammatory response, and prompt early recovery. These results suggest that TTP-PECS is an attractive alternative to TPVB for postoperative analgesia of modified radical mastectomy.

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Section: Discussionsupporting

confidence: 90%

Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modified radical mastectomy: a comparison with the thoracic paravertebral nerve block

et al. 2022

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“…Several retrospective studies (Zhang JY et al 2018), (Jiacen Li et al 2021) have found TTP-PECS to be effective as a postoperative analgesic technique and to reduce postoperative opioid consumption following breast surgeries. Under real-time US guidance, with the deposition of local anesthetic drugs into the fascial planes, the TTP-PECS would be more accurate to provide higher analgesic e cacy for mastectomy and axillary clearance because of its complete paranesthesia of the hemithorax (Ueshima H 2017).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Transversus Thoracic Muscle Plane-Pectoral Nerve Block for Postoperative Analgesia After Modified Radical Mastectomy: A Comparison with the Thoracic Paravertebral Nerve Block

Zhao

Jin

Pan

et al. 2021

Preprint

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Background: Modified radical mastectomy (MRM) is a most effective and common type of invasive surgery for breast cancer. However, it causes moderate to severe acute pain even last for a long postoperative period. Transversus thoracic muscle plane-pectoral nerve block (TTP-PECS) is a novel and promising interfacial plane block which can provide analgesia for MRM while thoracic paravertebral nerve block (TPVB) is also widely used for this purpose. This study compared the postoperative analgesia between the ultrasound-guided TTP-PECS and TPVB in patients undergoing MRM.Methods: In this randomized controlled pilot trial, eighty female breast cancer patients were randomized to receive either ultrasound-guided TTP-PECS (TTP-PECS group, n=40) or TPVB (TPVB group, n=40). The primary outcome was 24 h postoperative fentanyl consumption. Secondary outcome measures included intraoperative fentanyl and postoperative flurbiprofen axetil consumption, duration of analgesia, pain intensity at rest and during activity, inflammatory response, and the quality of recovery 40 (QoR-40) score.Results: Intraoperative fentanyl requirement was similar between the two groups; Postoperative fentanyl consumption was decreased in the TTP-PECS group copmared with the TPVB group, as well as the rate of postoperative flurbiprofen axetil consumption, but the duration of analgesia was longer; Pain scores at rest and during activity were dramatically decreased at postoperative 12 h; Moreover, the levels of IL-6, MCP-1 and TNF-α, as well as the levels of PGE2, NPY and β-endorphins were decreased at 12 h after surgery; Finally, the total QoR-40 score, especially for the scores of pain, emotional state and patient support were increased.Conclusion: Both TTP-PECS and TPVB are effective for analgesia after MRM. However, TTP-PECS reduced postoperative fentanyl and flurbiprofen axetil consumption in the first 24 h after MRM, and prolonged the duration of analgesia. Furthermore, TTP-PECS reduced postoperative pain intensity at rest and during activity, and inflammatory response at 12 h postoperation. Finally, TTP-PECS improved QoR-40 scores on the postoperative day. Thus, TTP-PECS is an attractive alternative to TPVB for postoperative analgesia after MRM.

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“…therefore, emerging evidence has suggested that the application of general anesthesia in HIV-infected individuals is safe and feasible (37,38). However, a previous study demonstrated that the cellular immune function, including the activity of natural killer cells, t-lymphocytes, monocytes and neutrophils, was further impaired following general anesthesia (39). General anesthetics-mediated immunosuppression can occur within 15 min following the induction of anesthesia and can last for 3-11 days.…”

Section: Intra-operative Strategymentioning

confidence: 99%

Surgical pathway for HIV‑infected patients based on the ERAS strategy (Review)

Mao,

Jiang,

Zeng

et al. 2024

Med Int

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A randomised trial: effects of different anesthesia methods on early perioperative pain sensitivity and cellular immune function in patients undergoing radical mastectomy

Cited by 5 publications

References 15 publications

Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modified radical mastectomy: a comparison with the thoracic paravertebral nerve block

Ultrasound-guided transversus thoracic muscle plane-pectoral nerve block for postoperative analgesia after modified radical mastectomy: a comparison with the thoracic paravertebral nerve block

Ultrasound-Guided Transversus Thoracic Muscle Plane-Pectoral Nerve Block for Postoperative Analgesia After Modified Radical Mastectomy: A Comparison with the Thoracic Paravertebral Nerve Block

Surgical pathway for HIV‑infected patients based on the ERAS strategy (Review)

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