Marrone F, Fusco P F, Paventi S, Tomei M, Failli S, Fabbri F, Pullano C
Unit of Anaesthesia and Intensive Care Santo Spirito Hospital Rome Italy.
Unit of Anaesthesia and Intensive Care SS Filippo e Nicola Hospital Avezzano L'Aquila Italy.
Anaesth Rep. 2024 May 1;12(1):e12294. doi: 10.1002/anr3.12294. eCollection 2024 Jan-Jun.
Worldwide, breast cancer is the most commonly diagnosed cancer in women. Surgical procedures are typically performed using general anaesthesia, often complemented by regional anaesthesia to manage postoperative pain. However, avoidance of general anaesthesia for breast surgery may be desirable for clinical reasons or patient choice. It is theorised that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes, and there is some evidence to support this. While many patients successfully undergo awake breast surgery, a limited number of anaesthetists possess direct experience of this approach, despite familiarity with regional anaesthesia techniques. Undertaking regional anaesthesia for awake breast surgery requires patient cooperation and excellent staff teamwork. Here, we present a case of a patient who underwent awake bilateral mastectomy with reconstruction. This was carried out under two 'paravertebral-by-proxy' blocks: the thoracic erector spinae plane and inter-transverse plane blocks, with intravenous sedation.
在全球范围内，乳腺癌是女性中最常被诊断出的癌症。外科手术通常在全身麻醉下进行，常辅以区域麻醉来控制术后疼痛。然而，出于临床原因或患者选择，避免对乳腺癌手术使用全身麻醉可能是可取的。理论上，使用区域麻醉以及避免使用挥发性麻醉剂和阿片类镇痛药可能对肿瘤学结局有有益影响，并且有一些证据支持这一点。虽然许多患者成功接受了清醒乳腺手术，但尽管熟悉区域麻醉技术，仍只有少数麻醉医生有这种方法的直接经验。为清醒乳腺手术进行区域麻醉需要患者的配合以及出色的医护团队协作。在此，我们展示一例接受清醒双侧乳房切除并重建手术的患者病例。该手术在两个“替代椎旁”阻滞下进行：胸段竖脊肌平面阻滞和横突间平面阻滞，并辅以静脉镇静。
