Department of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Barış Bulvarı Kadıköy Mahallesi No : 199 PK : 55090 İlkadım, Samsun, Turkey.
Department of General Surgery, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey.
BMC Anesthesiol. 2024 Sep 20;24(1):337. doi: 10.1186/s12871-024-02725-0.
Breast cancer is the most prevalent cancer among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast cancer surgery has emerged as an alternative due to risks associated with general anesthesia and patient preference.
This prospective observational study, conducted from July 2022 to July 2023, evaluated the effectiveness of ultrasound-guided fascial plane blocks for awake breast surgery. Patients aged 18-80 years undergoing unilateral breast surgery were included, following ethical committee approval and written informed consent. Exclusion criteria were prior breast surgery, coagulopathies, infections, allergies to local anesthetics, psychiatric disorders, body mass index over 40 kg/m², and chest deformities. The combination of interpectoral, pecto-serratus, and deep serratus plane blocks was used as the primary anesthetic method, with a superficial parasternal block added in cases where complete cutaneous coverage was not achieved.
Seventeen patients were enrolled. The primary outcome, sufficient surgical anesthesia without deep sedation, was achieved in 15 patients. The combination of the aforementioned blocks proved effective, with an average surgery duration of 59.66 min, and propofol requirements averaging 1.77 mg/kg/hour. Most patients reported high satisfaction levels, and no early or late block-related complications were observed.
The combination of fascial plane blocks is a viable option for awake breast cancer surgery, potentially eliminating the need for more invasive anesthesia techniques. Further studies are necessary to confirm these findings in larger, homogeneous patient groups.
乳腺癌是女性最常见的癌症之一，通常需要手术干预。虽然像保乳术这样的手术可以在局部麻醉下进行，但更广泛的手术通常需要全身麻醉。由于全身麻醉相关的风险和患者偏好，清醒乳腺癌手术已成为一种替代方法。
这项前瞻性观察研究于 2022 年 7 月至 2023 年 7 月进行，评估了超声引导筋膜平面阻滞在清醒乳房手术中的有效性。纳入年龄在 18-80 岁之间、单侧乳房手术的患者，在伦理委员会批准和书面知情同意后进行。排除标准为既往乳房手术、凝血功能障碍、感染、局部麻醉剂过敏、精神障碍、体重指数超过 40 kg/m²和胸部畸形。胸肌间、胸肌-前锯肌和深层前锯肌平面阻滞的联合作为主要麻醉方法，如果不能完全覆盖皮肤，则增加浅表胸骨旁阻滞。
共纳入 17 例患者。主要结局为无需深度镇静即可获得足够的手术麻醉，15 例患者达到该结局。上述阻滞的联合应用效果良好，手术平均持续时间为 59.66 分钟，丙泊酚需求量平均为 1.77 mg/kg/小时。大多数患者报告满意度高，且未观察到早期或晚期阻滞相关并发症。
筋膜平面阻滞联合应用是清醒乳腺癌手术的一种可行选择，可能无需使用更具侵入性的麻醉技术。需要进一步的研究在更大、更同质的患者群体中证实这些发现。
