Awake Breast Surgery: A Systematic Review

Abstract

Background/Aim: Awake surgery has become a valid alternative to general anesthesia in many surgery fields. This technique played a very important role during the COVID-19 period. The growing use of this technique has many advantages. We performed a systematic review to study the potentialities of awake breast surgery. Materials and Methods: We searched Pubmed, Embase, and Cochrane library database and retrieved a total of 109 records. Fortynine of them were excluded as unsuitable. Finally, we selected a total of 12 records concerning different types of studies for topic appropriateness. Three reviewers reviewed independently each record. Results: Five articles analyzing the sustainability of awake surgery during the COVID-19 period were selected. In addition, one article analyzing the impact on the immune system and six articles and eight case reports analyzing anesthetic techniques were also selected. The studies analyzing awake breast surgery during the COVID-19 period showed advantages in terms of sustainability and length of hospitalization. The study analyzing the immune response after awake breast surgery showed lesser lymphocyte response than the general anesthesia group. The studies analyzing anesthetic techniques in awake breast surgery showed that the nerve blocks allow good level of safety and postoperative pain control. Conclusion: The awake breast surgery and fast track implementation shortened hospital stays and reduced costs, without influencing the surgical results. Furthermore, awake breast surgery reduced surgical stress compared to general anesthesia. Among the various anesthetic techniques, nerve blocks are the most advantageous in terms of safety and efficacy compared to epidural anesthesia.Historically, surgery mainly required support with general anesthesia. The practice of surgical interventions on awake patients under local anesthesia, with or without mild sedation, has gained popularity in recent years. Awake surgery is currently proposed for surgical procedures in which the patient was previously expected to be intubated. Surgery with local anesthesia on an awake patient is a valid alternative for different types of surgery such as hand surgery, neurosurgery, spinal surgery, and cardiac surgery. In all these, awake surgery appears to be advantageous in terms of costs, associated symptoms, and recovery after surgery, without increasing the surgical burden on the patient or on the result of the operation (1-4).In neurosurgery, awake strategy can be used in intraoperative brain mapping. In these cases, many techniques such as local 1412

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“…Shorter duration of hospital stay and reduced costs have been reported without influencing outcomes. Recent studies [15,16] have shown that awake breast surgery is associated with reduced surgical stress when compared to general anaesthesia.…”