Dilutional local anaesthetic techniques in oncoplastic breast surgery and potential benefits during the COVID-19 pandemic and beyond

Abstract

Introduction COVID-19 has changed the approach to operating on breast cancer for the benefit of patients, staff and the general population. One approach involves the switch from operating under general to local anaesthetic. We assess whether diluational local anaesthetic is as effective as the current standard approach. Methods Postoperative pain was recorded in prospective, consecutive patients undergoing wide local excision under dilutional local anaesthetic (concentration < 1mg/ml). Pain scores were documented at 0, 30 and 60 minutes and compared to a control group consisting of combined general with local anaesthetic. Results Pain significantly increased in the control group during the postoperative recovery. This was not seen in the dilutional local anaesthetic group that was non-inferior to the standard approach at 0, 30 and 60 minutes. Conclusion Dilutional local anaesthetic provides a safe and effective alternative approach to operating on breast cancer patients whilst avoiding risky general anaesthetic in a COVID-19 pandemic environment.

The Effects of COVID-19 on Cancer Care Provision: A Systematic Review

“… 49 In addition, attempts to switch from general anesthesia to local or regional anesthesia were observed during sentinel lymph node biopsies and breast cancer surgery in some UK centers. 42 , 76 In the US, robotic technique was preferred over open surgery when managing urological cancers, while some others reported use of enhanced recovery programs after surgery protocols to minimize hospital stay. 14 , 70 Patients who were also candidates for supportive therapy alone or eligible for alternate non-surgical treatment were excluded from hospitalization.…”

“…If a comparable non-surgical option was available, then this was conducted instead of surgery Baabdullah et al 67 Survey Saudi Arabia 1. Adopted telephone consultations in Oncology Departments with patients being able to access patient-accessible electronic records Outcome: Survey reveals that transition to telemedicine is well accepted by cancer patients Batt et al 76 Prospective cohort study UK 1. Treatment adaptation-switched to local anesthesia from general anesthesia in selected patients with breast cancer.…”

Anestesia regional como alternativa para procedimentos médicos na pandemia da COVID-19

“…Foi concluído que a escolha da anestesia foi uma opção válida para o procedimento, especialmente durante a pandemia de coronavírus, reduzindo a necessidade dos cuidados intensivos (Días et al, 2021). Batt et al (2020) avaliou se a dose máxima padronizada de lidocaína, um AL, forneceria analgesia eficaz no período perioperatório e pós-operatório quando diluída (< 1 mg/mL), reduzindo a preocupação da toxicidade relativa comparando-a com um grupo controle. Foi observado aumento significativo da dor pós-operatória no grupo controle quando comparado com Research, Society and Development, v. 10, n. 7, e37810716636, (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i7.16636 o grupo experimental.…”

“…Foi observado aumento significativo da dor pós-operatória no grupo controle quando comparado com Research, Society and Development, v. 10, n. 7, e37810716636, (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i7.16636 o grupo experimental. Portanto, os autores concluem que o AL diluído é capaz de fornecer uma abordagem alternativa eficaz e segura para procedimentos cirúrgicos de câncer de mama, evitando a AG durante a pandemia da COVID-19 (Batt et al, 2020).…”

Effect on implant drills and postoperative reactions for pre-extraction interradicular implant bed preparation during the COVID-19 pandemic and beyond

“…The novel coronavirus disease 2019 (COVID- 19) was first reported in Wuhan, China, in December 2019, which led to fear among individuals and impacted their oral health. [1][2][3][4] Fear of COVID-19 was assessed using the fear of coronavirus disease 2019 scale (FCV-19S), which is a seven-item unidimensional scale with robust psychometric properties. [5,6] All elective dental treatments were delayed, which increased the incidence of dental-related infections and emergencies.…”