A randomized single-blinded, parallel-arm group feasibility trial evaluating role of pectoral nerve block on serum vascular endothelial growth factor levels in patients undergoing unilateral modified radical mastectomy

Abstract

Metastatic breast cancer cells carry adult and neonatal variants of NaV1.5 voltage-gated activated Na + channels involved in cell invasion. We hypothesize that instilling lignocaine near the surgical field to anesthetize the pectoral nerves for analgesia will decrease angiogenesis by blocking voltage-gated activated Na + channels. Twenty patients undergoing unilateral modified radical mastectomy were randomized in a single-blinded, parallel-arm group feasibility pilot study in two groups. In Group I a catheter was placed between the pectoralis major and minor muscle under direct vision before skin closure. Ten milliliters of 2% lignocaine was given as an initial bolus followed by 10 mL of 2% lignocaine every 8 hours up to 24 hours. Group II did not receive any regional block. Primary measure outcomes were pre and postoperative changes in levels of vascular endothelial growth factor. Secondary outcomes were postoperative pain scores and total rescue analgesia used. Nine patients in each group were analyzed. Baseline demographic data of all females were similar with respect to age, body mass, height and duration of anesthesia. Postoperative mean serum levels of vascular endothelial growth factor were decreased by 46.60% from baseline in Group I, while were increased by 84.27% as compared to preoperative values in Group II. Postoperative average pain scores were less in Group I. Postoperative rescue analgesia in 24 hours in Group I was lower than that in Group II. There was no postoperative adverse event related to catheter or lignocaine administration at given doses. Instilling lignocaine to block pectoral nerves provides better postoperative analgesia and decreases a marker of angiogenesis. The study protocol was approved by the Institutional Ethical Committee of the Tertiary Centre (All India Institute of Medical Sciences Rishikesh India) (No. AIIMS/IEC/19/1002) on August 9, 2019, and the larger expansion trial was prospectively registered on Clinical Trial Registry India (No. CTRI/2020/01/022784) on January 15, 2020.

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“…Propofol was found to reduce vascular endothelial growth factor, a marker for angiogenesis, during breast surgery; however, no significant short-term effect on breast cancer recurrence was observed ( 72 ) ( Figure 3 ). In a parallel approach, lignocaine administered in the surgical field of a modified radical mastectomy led to decreased angiogenesis markers and better postoperative analgesia ( 73 ). Although anesthesia’s causality of metastatic spread has been thoroughly studied, there remains a lack of conclusive evidence that anesthetic choice and route contribute to cancer progression.…”

SP51 RA and best outcomes for breast surgery

“…5 Neshith Govil et al demonstrated that instillation of lignocaine to block the pectoral nerves allows better postoperative analgesia compared to other patients without regional anaesthesia and decreases the secretion of angiogenesis markers, which contributes to tumor generalization. 6 Hip fracture is associated with moderate-to-severe pain, both pre-and post-operatively. Emergent or semi-emergent surgical repair is considered mandatory in most cases.…”