Local and Paravertebral Block Anesthesia for Outpatient Elective Breast Cancer Surgery

Abstract

Most breast cancer operations in the United States are performed with the patient given general anesthesia. We retrospectively reviewed our prospective breast cancer database to determine the percentage of patients who underwent breast cancer operations with either local or paravertebral block regional anesthesia from January 1 through June 30, 2008. Fifty-two of 70 patients (74%) were able to undergo breast cancer surgery with local or paravertebral block regional anesthesia. Operations included mastectomy, full axillary dissections, and expander or implant reconstruction. There were no conversions to general anesthesia and no unplanned overnight admissions. Only 5 of 52 patients (10%) undergoing surgery with local or paravertebral block regional anesthesia developed postoperative nausea or vomiting. We conclude that most elective outpatient breast cancer surgery operations can be performed with the patients given local or regional anesthesia.

Are Cure Rates for Breast Cancer Improved by Local and Regional Anesthesia?

“…18,19,[23][24][25][26][27] The majority of breast cancer patients undergoing operation in our institution receive local anesthesia with sedation or a PVB, a practice pattern that differs from many other community, academic, and Veterans Affairs hospitals. 2,18 Our setting is suited for the study of different anesthesia types on cancer outcomes because we were early adopters, then advocates, of PVB. 18,19 Greater than 60% of our breast cancer patients undergoing resection receive LRA.…”

“…2,18 Our setting is suited for the study of different anesthesia types on cancer outcomes because we were early adopters, then advocates, of PVB. 18,19 Greater than 60% of our breast cancer patients undergoing resection receive LRA. 18 The patient-centered benefits of LRA over GA include better pain control and fewer narcotic requirements, as well as reductions in postoperative nausea, vomiting, chronic pain syndromes, and unplanned overnight admissions.…”

“…18 The patient-centered benefits of LRA over GA include better pain control and fewer narcotic requirements, as well as reductions in postoperative nausea, vomiting, chronic pain syndromes, and unplanned overnight admissions. 18,19,[23][24][25][26][27] The hypothesis that anesthesia affects breast cancer recurrence was proposed in 2006. 11 Recently, it was deemed "one of the most important research questions in the [anesthesia] specialty."…”

“…The structure and outcomes of breast care and anesthesia for breast surgery at this institution have been previously described. [18][19][20] All operations were performed by 1 of 2 breast surgeons (J.L. or J.M.J.).…”

Choices in Surgery for Older Women with Breast Cancer

“…The technique was first used by Morton et al [62] with blue dye and later by Van der Veen et al [63] with lymphoscintigraphy to select melanoma patients for regional node dissection [47]. The use of SLNB is applicable to most breast cancer patients, with only a small fraction of patients thesia include low rates of postoperative nausea and vomiting as well as excellent pain control [33]. Wide local excision is almost always possible under LA, whereas for a larger breasted woman mastectomy under LA may not be feasible due to the toxicity of large volumes of local anaesthetic.…”