Cervical epidural anesthesia for carcinoma breast surgery as the sole anesthesia modality
Vol 5 | Issue 2 | May-Aug 2019 | page: 6-9 | Gauri Arora
Authors: Gauri Arora [1]
[1] Consultant Anesthesiologist, Nagpur, Maharashtra, India 440012
Address of Correspondence
Dr. Gauri Arora,
Arora Hospital, 1st Floor,Shreewardhan complex, Near Landmark building,Ramdaspeth, Nagpur, Maharashtra- 440012, India.
E-mail: gauriarora1@yahoo.in
Abstract
Objective: The study is aimed to evaluate the feasibility and safety of cervical epidural anesthesia as the sole anesthetic technique for modified radical mastectomy done for carcinoma breast.
Method: Thirty six breast cancer patients of ASA (American Society of Anesthesiologists) grade I and II underwent MRM under CEA from February 2012 to December 2016. Anesthesia was induced with 12 ml of 1% lignocaine with adrenaline, administered through an 18-gauge cervical epidural catheter placed at C(7)-T(1) epidural space. Top-up dose was given after 1 hour 15 minutes to all the patients with 6ml of 0.25% Bupivacaine and 50 microgram of Fentanyl injection. All patients were given intravenous sedation with midazolam. Oxygen supplemented nasally. In one patient as a planned procedure, an additional lumbar epidural block was given to raise skin graft to fill the defect. In another patient where skin grafting was unplanned, Injection Ketamine 100mg was used. The mean operative time was 123.71± 24.96 minutes.Postoperative analgesia was maintained with Diclofenac Sodium Injection 75 mg at the end of surgery followed by Tramadol injection through the epidural catheter for the first 24 hours according to VAS score. The parameters considered were pulse, blood pressure, oxygen saturation, Supplementation or conversion to GA, blood loss, post-op analgesia and nausea vomiting.
Results: One patient was excluded from the study due to blood tap during catheter placement. Three patients had bradycardia and four patients had hypotension which was treated accordingly. No patient required blood transfusion. No nausea or vomiting in the intra-operative or post operative period. Supplementation or conversion to general anesthesia was not required in any patient. All patients were started on a liquid diet 4 hours after surgery and were mobilized early. Post-operative analgesic requirement was also found to be less.
Conclusion: In this study cervical epidural anesthesia has been found to be not only feasible but also safe and can be used as sole anesthesia modality in cases of carcinoma breast surgery, but it needs to be studied in larger sample population.
Keywords: Cervical epidural, Anesthesia, Breast surgery, Ketamine, Lignocaine, Adrenaline, Bupivacaine.
References
- SantpurMU, KahalekarGM, KanniP, RSL Bhargavi, LosariA.Cervical Epidural Anaesthesia for Breast and Thyroid Surgeries – A Safe Alternative Approach to General Anaesthesia;International Journal of Science and Research (IJSR) 2015;4(2):61-62.
- Khanna R,Singh DK.Cervical epidural anaesthesia for thyroid surgery. Kathmandu Univ Med J 2009;7:242-5.
- Dhummansure D, Kamtikar S, Haq MM, Patil Efficacy and safety of cervical epidural anesthesia for Thyroid surgery.International Journal of scientific study 2015;3;7:245-50 .
- Wenk M, Massoth C, Popping DM and Michael M. Feasibility of Cervical Epidural Anaesthesia for Breast Cancer Surgery. Hindawi Anesthesiology Research and Practice 2017, Article ID 7024924, 5 pages https://doi.org/10.1155/2017/7024924
- Kulkarni K, Namazi IJ, Deshpande S, GoelR.Cervical Epidural Anaesthesia with Ropivacaine for Modified Radical Mastectomy. Kathmandu Univ Med J 2013 ;11 : 126
- Michalek P, David I, Adamec M, JanousekL.Cervical epidural anaesthesia for combined neck and upper limb procedures .AnesthAnalg 2004;99:1833-6.
- Harald G, Beatrix S, Pavlakonic et.al. Lung functions under high thoracic segmental epidural anesthesia with ropivacaine or bupivacaine in patients with severe obstructive. Pulmonary disease undergoing breast surgeries. Anesthesiology 2002;96:536-41
- Stevens RA, Stevens MM. Cervical and high thoracic epidural anesthesia as the sole anesthetic for breast surgery. Techniques in regional anesthesia and pain management 1998;2:13-18.
- Santanche G, Goedecke A. Hemodynamic and respiratory changes in cervical peridural anesthesia. RegAnaesth 1989;12:110–116
- Bonnet F, Derosier JP, PluskwaF,AbhayK,GaillardA.Cervical epidural anaesthesia for carotid artery surgery. Can J Anaesth1990;37;353-8.
- Singh AP, Tewari M, Singh DK, ShuklaHS.Cervical epidural anesthesia: A safe alternative to general anesthesia for patients undergoing cancer breast surgery. World J Surg. 2006;30:2043–2047.
- Vaughan RS – Pain relief after thoracotomy. Br J Anaesth, 2001;87:681-683.
- Yeh CC, Yu JC, Wu CT, et al. Thoracic epidural anasthesia for pain relief and post operation recovery with modified radical mastectomy. World J Surg 1999;23:256–260
- Stevenson GW, Hall SC, Rudnick S – The effect of anesthetic agents on the human immune response. Anesthesiology, 1990; 72:542-552.
- Colucci DG, Puig NR, Hernandez Pando R. Influence of anaesthetic drugs on immune response: from inflammation to immunosuppression. OA Anaesthetics 2013;30;1(3):21.
- Doss NW, Ipe J, Crimi T, et al. Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy. AnesthAnalg 2001;92:1552–1557.
How to Cite this Article: Arora G. Cervical epidural anesthesia for carcinoma breast surgery as the sole anesthesia modality. Journal of Anaesthesia and Critical Care Case Reports May-Aug 2019; 5(2): 6-9. |
(Abstract) (Full Text HTML) (Download PDF)
.