Bristol Breast Care Centre, Southmead Hospital North Bristol NHS Trust, Bristol, BS10 5NB, UK.
Bristol Breast Care Centre, Southmead Hospital North Bristol NHS Trust, Bristol, BS10 5NB, UK.
Surgeon. 2020 Apr;18(2):91-94. doi: 10.1016/j.surge.2019.06.006. Epub 2019 Aug 23.
Breast cancer surgery under local anaesthesia (LA) can be challenging due to limitation of dose and quantity of anaesthetic agent that can be used safely. Elderly patients with breast cancer and with multiple co-morbidities are often prevented from having a standard treatment as they are considered unfit for general anaesthesia. We describe a technique of surgery under local anaesthesia without sedation that employs dilution to generate large volumes of LA and infiltration under ultrasound guidance.
We present a case series by a single surgeon of breast cancer patients who underwent surgery under LA. 40 mls of 1% lignocaine with 1:200,000 adrenaline was diluted with 160 mls of normal saline to make a total of 200 mls, resulting in dilution to a concentration of 0.2% lignocaine. Radioactive isotope having been injected before patient's arrival in theatre, 1 ml of diluted anaesthetic solution is used with 2 mls of 2.5% patent blue to inject in the sub-areolar space. Local anaesthetic is infiltrated at operative site under ultrasound guidance using a long echogenic needle.
A total of 71 patients with breast cancer underwent surgery under the LA between September 2015 and October 2018. 64 (90%) patients had wide local excisions and 7 (10%) had mastectomies. All had axillary surgery, 65 (91.5%) had dual technique sentinel lymph node biopsy as a day case and 6 (8.5%) patients had axillary clearance. 8 patients had re excision (12.5%). All patients had '0' pain score and no postoperative analgesia was required in recovery. Local anaesthetic used did not exceed the maximum safe dose in any of the cases. One patient returned to theatre for postoperative wound bleeding. No other postoperative complication was observed.
Ultrasound guided infiltration allows accurate placement of large volume of diluted local anaesthetic solution safely and provides effective anaesthesia.
由于可安全使用的麻醉剂剂量和数量有限，局部麻醉（LA）下的乳腺癌手术可能具有挑战性。患有乳腺癌且合并多种合并症的老年患者通常因不适合全身麻醉而无法接受标准治疗。我们描述了一种在没有镇静的情况下进行局部麻醉下手术的技术，该技术采用稀释方法产生大量 LA，并在超声引导下进行浸润。
我们由一位外科医生报告了一组接受 LA 下手术的乳腺癌患者的病例系列。将 40ml 浓度为 1%的利多卡因与 1:200,000 的肾上腺素混合，再加入 160ml 生理盐水，制成总共 200ml 的混合物，从而使浓度稀释至 0.2%的利多卡因。在患者到达手术室之前，已注射放射性同位素，使用 1ml 稀释的麻醉溶液和 2ml 2.5%的专利蓝，在乳晕下间隙注射。在超声引导下，使用长超声探头将局部麻醉剂浸润到手术部位。
2015 年 9 月至 2018 年 10 月期间，共有 71 例乳腺癌患者在 LA 下接受了手术。64 例（90%）患者进行了广泛局部切除术，7 例（10%）患者进行了乳房切除术。所有患者均进行腋窝手术，65 例（91.5%）患者进行双技术前哨淋巴结活检术，并在日间病房进行，6 例（8.5%）患者进行腋窝清扫术。8 例患者需要再次切除（12.5%）。所有患者的疼痛评分为 0 分，在恢复过程中无需术后镇痛。在任何情况下，使用的局部麻醉剂均未超过最大安全剂量。有 1 例患者返回手术室治疗术后伤口出血。未观察到其他术后并发症。
超声引导下浸润可安全、准确地放置大量稀释的局部麻醉溶液，并提供有效的麻醉效果。
