Comparación entre anestesia general con o sin bloqueo paravertebral preincisional con dosis única y dolor crónico postquirúrgico, en cirugía radical de cáncer de mama

Martí, M.L. Ibarra; G-Cuenca, M. S-Carralero; Gutiérrez, U. Vicente; Pozo, A. Cuartero del; Rincón, Rodríguez; Castillo, M.J. Fajardo del

doi:10.1016/s0034-9356(11)70064-0

Cited by 35 publications

(41 citation statements)

References 22 publications

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“…[4] Thoracic paravertebral block (PVB) proved efficacy as a lone anesthesia regimen for breast surgery. [4567]…”

Section: Introductionmentioning

confidence: 99%

Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Sultan

2013

Saudi J Anaesth

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Context:Cytokine release is a well-known response to surgery especially when it is linked to cancer. Paravertebral block (PVB) is the suitable regional anesthesia for breast surgery.Aim:We tested the effect of replacing general anesthesia (GA) with PVB on cytokine response during and after surgeries for cancer breast.Settings and Design:Controlled randomized study.Methods:Forty cancer breast patients were divided in two groups; Group I received PVB and Group II received GA during performance of unilateral breast surgery without axillary clearance. Plasma concentrations of interleukin (IL)-6, IL-10, IL-12 and interferon-γ (IFN-γ) were measured and IL-10/IFN-γ were estimated in the following points; before starting PVB in Group I or induction of GA in Group II (Sample A), before skin incision (Sample B), at the end of procedure before shifting out of operating room (Sample C), 4-h post-operatively (Sample D) and 24-h post-operatively (Sample E).Statistical Analysis:unpaired Student t-test.Results:IL-6 increased progressively in both groups with statistically significant lower levels in samples C and D in Group I. IL-10 levels showed progressive increasing in both groups without differences between groups. IL-12 showed progressive decrease in both groups with statistically significant higher levels in samples C and D in Group I. IFN-levels showed significantly higher levels in samples C and D in Group I. IL-10/IFN-γ ratio was significantly lower in Group II in samples C and D.Conclusion:Replacing GA with PVB can attenuate cytokines response to cancer breast surgeries.

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“…[4] Thoracic paravertebral block (PVB) proved efficacy as a lone anesthesia regimen for breast surgery. [4567]…”

Section: Introductionmentioning

confidence: 99%

Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Sultan

2013

Saudi J Anaesth

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“…One trial compared epidural analgesia to epidural saline plus standard management of thoracotomy pain (Nikolajsen et al, 1997). Two trials examined the impact of paravertebral block for mastectomy patients (Kairaluoma et al, 2006; Ibarra et al, 2011). One trial had five study arms that studied epidural therapy, fentanyl patient-controlled analgesia (PCA) and standard therapy before, during and after amputation (Karanikolas et al, 2011).…”

Section: Resultsmentioning

confidence: 99%

“…The first trial found that paravertebral block significantly reduced acute pain and chronic pain 1 year later compared with sham block (Kairaluoma et al, 2006). The second trial found that paravertebral block had no significant impact on acute pain, but reduced the prevalence of chronic pain, compared with control (Ibarra et al, 2011). One trial compared preoperative epidural commencement with low-dose intravenous remifentanil infusion versus post-operative epidural commencement with a high-dose intravenous remifentanil infusion for thoracotomy patients (Salengros et al, 2010).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of therapeutic interventions to reduce acute and chronic post‐surgical pain after amputation, thoracotomy or mastectomy

Humble

Dalton

2014

European Journal of Pain

191

150

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BackgroundPerioperative neuropathic pain is under-recognized and often undertreated. Chronic pain may develop after any routine surgery, but it can have a far greater incidence after amputation, thoracotomy or mastectomy. The peak noxious barrage due to the neural trauma associated with these operations may be reduced in the perioperative period with the potential to reduce the risk of chronic pain.Databases and data treatmentA systematic review of the evidence for perioperative interventions reducing acute and chronic pain associated with amputation, mastectomy or thoracotomy.ResultsThirty-two randomized controlled trials met the inclusion criteria. Gabapentinoids reduced pain after mastectomy, but a single dose was ineffective for thoracotomy patients who had an epidural. Gabapentinoids were ineffective for vascular amputees with pre-existing chronic pain. Venlafaxine was associated with less chronic pain after mastectomy. Intravenous and topical lidocaine and perioperative EMLA (eutectic mixture of local anaesthetic) cream reduced the incidence of chronic pain after mastectomy, whereas local anaesthetic infiltration appeared ineffective. The majority of the trials investigating regional analgesia found it to be beneficial for chronic symptoms. Ketamine and intercostal cryoanalgesia offered no reduction in chronic pain. Total intravenous anaesthesia (TIVA) reduced the incidence of post-thoracotomy pain in one study, whereas high-dose remifentanil exacerbated chronic pain in another.ConclusionsAppropriate dose regimes of gabapentinoids, antidepressants, local anaesthetics and regional anaesthesia may potentially reduce the severity of both acute and chronic pain for patients. Ketamine was not effective at reducing chronic pain. Intercostal cryoanalgesia was not effective and has the potential to increase the risk of chronic pain. TIVA may be beneficial but the effects of opioids are unclear.

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“…However, even with paravertebral block around twenty-two percent of women undergoing breast cancer surgery suffer from persistent pain six months after surgery [22, 23]. To further improve management of surgical pain it would be useful to understand the effect of adding inhibition of the inflammatory component of sensitization, e.g.…”

Section: Introductionmentioning

confidence: 99%

Hyperalgesia and Persistent Pain after Breast Cancer Surgery: A Prospective Randomized Controlled Trial with Perioperative COX-2 Inhibition

et al. 2016

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BackgroundPersistent pain is a challenging clinical problem after breast cancer treatment. After surgery, inflammatory pain and nociceptive input from nerve injury induce central sensitization which may play a role in the genesis of persistent pain. Using quantitative sensory testing, we tested the hypothesis that adding COX-2 inhibition to standard treatment reduces hyperalgesia after breast cancer surgery. A secondary hypothesis was that patients developing persistent pain would exhibit more postoperative hyperalgesia.Methods138 women scheduled for lumpectomy/mastectomy under general anesthesia with paravertebral block were randomized to COX-2 inhibition (2x40mg parecoxib on day of surgery, thereafter 2x200mg celecoxib/day until day five) or placebo. Preoperatively and 1, 5, 15 days and 1, 3, 6, 12 months postoperatively, we determined electric and pressure pain tolerance thresholds in dermatomes C6/T4/L1 and a 100mm VAS score for pain. We calculated the sum of pain tolerance thresholds and analyzed change in these versus preoperatively using mixed models analysis with factor medication. To assess hyperalgesia in persistent pain patients we performed an additional analysis on patients reporting VAS>30 at 12 months.Results48 COX-2 inhibition and 46 placebo patients were analyzed in a modified intention to treat analysis. Contrary to our primary hypothesis, change in the sum of tolerance thresholds in the COX-2 inhibition group was not different versus placebo. COX-2 inhibition had an effect on pain on movement at postoperative day 5 (p<0.01). Consistent with our secondary hypothesis, change in sum of pressure pain tolerance thresholds in 11 patients that developed persistent pain was negative versus patients without pain (p<0.01) from day 5 to 1 year postoperatively.ConclusionsPerioperative COX-2 inhibition has limited value in preventing sensitization and persistent pain after breast cancer surgery. Central sensitization may play a role in the genesis of persistent postsurgical pain.

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Comparación entre anestesia general con o sin bloqueo paravertebral preincisional con dosis única y dolor crónico postquirúrgico, en cirugía radical de cáncer de mama

Cited by 35 publications

References 22 publications

Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

A systematic review of therapeutic interventions to reduce acute and chronic post‐surgical pain after amputation, thoracotomy or mastectomy

Hyperalgesia and Persistent Pain after Breast Cancer Surgery: A Prospective Randomized Controlled Trial with Perioperative COX-2 Inhibition

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