Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy.
Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy;
In Vivo. 2023 Jul-Aug;37(4):1412-1422. doi: 10.21873/invivo.13225.
BACKGROUND/AIM: Awake surgery has become a valid alternative to general anesthesia in many surgery fields. This technique played a very important role during the COVID-19 period. The growing use of this technique has many advantages. We performed a systematic review to study the potentialities of awake breast surgery.
We searched Pubmed, Embase, and Cochrane library database and retrieved a total of 109 records. Forty-nine of them were excluded as unsuitable. Finally, we selected a total of 12 records concerning different types of studies for topic appropriateness. Three reviewers reviewed independently each record.
Five articles analyzing the sustainability of awake surgery during the COVID-19 period were selected. In addition, one article analyzing the impact on the immune system and six articles and eight case reports analyzing anesthetic techniques were also selected. The studies analyzing awake breast surgery during the COVID-19 period showed advantages in terms of sustainability and length of hospitalization. The study analyzing the immune response after awake breast surgery showed lesser lymphocyte response than the general anesthesia group. The studies analyzing anesthetic techniques in awake breast surgery showed that the nerve blocks allow good level of safety and postoperative pain control.
The awake breast surgery and fast track implementation shortened hospital stays and reduced costs, without influencing the surgical results. Furthermore, awake breast surgery reduced surgical stress compared to general anesthesia. Among the various anesthetic techniques, nerve blocks are the most advantageous in terms of safety and efficacy compared to epidural anesthesia.
背景/目的：在许多外科领域，清醒手术已成为全身麻醉的有效替代方法。在 COVID-19 期间，该技术发挥了非常重要的作用。这种技术的使用越来越多，具有许多优点。我们进行了一项系统评价，以研究清醒乳房手术的潜力。
我们检索了 Pubmed、Embase 和 Cochrane 图书馆数据库，共检索到 109 份记录。其中 49 份因不合适而被排除。最后，我们共选择了 12 份记录，这些记录涉及不同类型的研究，以确定主题的适宜性。三位评审员独立审查了每一份记录。
选择了 5 篇分析 COVID-19 期间清醒手术可持续性的文章，1 篇分析对免疫系统影响的文章，6 篇和 8 篇病例报告分析麻醉技术的文章。分析 COVID-19 期间清醒乳房手术的研究表明，在可持续性和住院时间方面具有优势。分析清醒乳房手术后免疫反应的研究表明，与全身麻醉组相比，淋巴细胞反应较少。分析清醒乳房手术中麻醉技术的研究表明，神经阻滞可实现良好的安全性和术后疼痛控制。
清醒乳房手术和快速通道的实施缩短了住院时间并降低了成本，而不会影响手术结果。此外，与全身麻醉相比，清醒乳房手术减轻了手术应激。在各种麻醉技术中，与硬膜外麻醉相比，神经阻滞在安全性和疗效方面具有优势。
