Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis

Wong, Heung-Yan; Pilling, Rob J.; Young, Bruce W.M.; Owolabi, Adetokunbo A.; Onwochei, Desire N.; Desai, Neel

doi:10.1016/j.jclinane.2021.110274

Cited by 38 publications

(28 citation statements)

References 101 publications

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“…Owing to these advantages, TPVB has recently been preferred to TEA for thoracic surgery. For other surgeries (e.g., breast surgery), the excellent analgesic effect of TPVB is offset by concerns about the potential risk of pneumothorax [ 57 ]. However, concerns about pneumothorax are greatly reduced in VATS, which allows for the administration of TPVB without concern for this complication.…”

Section: Discussionmentioning

confidence: 99%

Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis

Park

et al. 2022

Korean J Anesthesiol

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Section: Discussionmentioning

confidence: 99%

Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis

Park

et al. 2022

Korean J Anesthesiol

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“…lumpectomies, partial mastectomies, modified radical mastectomies) and analgesic modalities (including single-injection, continuous infusion and the combination of regional analgesic techniques), making focused recommendations for a specific procedure like mastectomy challenging. Furthermore, the classification used by Wong et al 86 is now outdated given the novel nomenclature proposed by the ESRA/ASRA consensus. 8 In our article, we examined a single surgical intervention (mastectomy with or without lymph node dissection) and single-injection regional analgesia techniques, attempting to answer a more focused clinical problem and provide actionable information for the general anaesthesiologist.…”

Section: Discussionmentioning

confidence: 99%

Single-injection regional analgesia techniques for mastectomy surgery

Cassai

Zarantonello

Geraldini

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Patients undergoing mastectomy surgery experience severe postoperative pain. Several regional techniques have been developed to reduce pain intensity but it is unclear, which of these techniques is most effective.OBJECTIVES To synthesise direct and indirect comparisons for the relative efficacy of different regional and local analgesia techniques in the setting of unilateral mastectomy. Postoperative opioid consumption at 24 h, postoperative pain at extubation, 1, 12 and 24 h, postoperative nausea and vomiting were collected.DESIGN Systematic review with network meta-analysis (PROSPERO: CRD42021250651).DATA SOURCE PubMed, Scopus, the Cochrane Central Register of Controlled Trials (from inception until 7 July 2021).ELIGIBILITY CRITERIA All randomised controlled trials investigating single-injection regional and local analgesia techniques in adult patients undergoing unilateral mastectomy were included in our study without any language or publication date restriction.RESULTS Sixty-two included studies randomising 4074 patients and investigating nine techniques entered the analysis. All techniques were associated with less opioid consumption compared with controls The greatest mean difference [95% confidence interval (CI)] was associated with deep serratus anterior plane block: mean difference -16.1 mg (95% CI, -20.7 to -11.6). The greatest reduction in pain score was associated with the interpectoral-pectoserratus plane block (mean difference -1.3, 95% CI, -1.6 to -1) at 12 h postoperatively, and with superficial serratus anterior plane block (mean difference -1.4, 95% CI, -2.4 to -0.5) at 24 h. Interpectoral-pectoserratus plane block resulted in the greatest statistically significant reduction in postoperative nausea/vomiting when compared with placebo/no intervention with an OR of 0.23 (95% CI, 0.13 to 0.40).CONCLUSION All techniques were associated with superior analgesia and less opioid consumption compared with controls. No single technique was identified as superior to others. In comparison, local anaesthetic infiltration does not offer advantages over multimodal analgesia alone.TRIAL REGISTRATION PROSPERO (CRD4202125065).

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“… 21 Similarly, for breast surgery, local infiltration and anesthesia can be used for tumorectomy and mastectomy. 22 , 23 With this surgery, as very large volumes of LA are administered (20 to 40 mL), lidocaine 10 mg.mL −1 or diluted at 5 mg.mL −1 should be used to reduce systemic toxicity (resorption). In a case series, Nadeem et al demonstrated the efficacy of local anesthesia in 71 patients with breast cancer who underwent surgery: “65 (91.5%) had dual technique sentinel lymph node biopsy as a day case and 6 (8.5%) patients had axillary clearance.…”

Section: Local Anesthesia In Practice: Volume Concentration and Type ...mentioning

confidence: 99%

“… 20 For breast surgery, local infiltration and anesthesia can be used in tumorectomy and mastectomy. 22 , 23 …”

Section: Local Anesthesia In Practice: Volume Concentration and Type ...mentioning

confidence: 99%

“…20 For breast surgery, local infiltration and anesthesia can be used in tumorectomy and mastectomy. 22,23 The team's experience of performing long, complex surgery may be also analyzed. In one recent study (neurosurgical operations), Oh et al showed that, when surgery was performed under local anesthesia, poor pain control (severe pain, VAS>6.8) altered outcomes.…”

Section: Dovepressmentioning

confidence: 99%

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Considerations for the Use of Local Anesthesia in the Frail Elderly: Current Perspectives

Cuvillon¹,

Lefrant²,

Gricourt³

2022

LRA

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The frail, elderly population is at a high risk of postoperative complications. Besides perioperative rehabilitation techniques and management by geriatric teams, the least invasive techniques in anesthesia are required, making regional anesthesia very interesting in terms of benefit-risk ratio. Among them, local anesthesia is a simple, reproducible, inexpensive technique applied to many superficial or deep surgeries, which should make it a gold standard for the frail person. This review provides an update on the current possibilities for various surgeries and exclusion.

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Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis

Cited by 38 publications

References 101 publications

Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis

Regional analgesia techniques for video-assisted thoracic surgery: a frequentist network meta-analysis

Single-injection regional analgesia techniques for mastectomy surgery

Considerations for the Use of Local Anesthesia in the Frail Elderly: Current Perspectives

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