Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia

Marcio Matsumoto, Eva M Flores, Pedro P Kimachi, Flavia V Gouveia, Mayra A Kuroki, Alfredo C S D Barros, Marcelo M C Sampaio, Felipe E M Andrade, João Valverde, Eduardo F Abrantes, Claudia M Simões, Rosana L Pagano, Raquel C R Martinez, Marcio Matsumoto, Eva M Flores, Pedro P Kimachi, Flavia V Gouveia, Mayra A Kuroki, Alfredo C S D Barros, Marcelo M C Sampaio, Felipe E M Andrade, João Valverde, Eduardo F Abrantes, Claudia M Simões, Rosana L Pagano, Raquel C R Martinez

Abstract

Surgery is the first-line treatment for early, localized, or operable breast cancer. Regional anesthesia during mastectomy may offer the prevention of postoperative pain. One potential protocol is the combination of serratus anterior plane block (SAM block) with pectoral nerve block I (PECS I), but the results and potential benefits are limited. Our study compared general anesthesia with or without SAM block + PECS I during radical mastectomy with axillary node dissection and breast reconstruction using evaluations of pain, opioid consumption, side effects and serum levels of interleukin (IL)-1beta, IL-6 and IL-10. This is a prospective, randomized controlled trial. Fifty patients were randomized to general anesthesia only or general anesthesia associated with SAM block + PECS I (25 per group). The association of SAM block + PECS I with general anesthesia reduced intraoperative fentanyl consumption, morphine use and visual analog pain scale scores in the post-anesthetic care unit (PACU) and at 24 h after surgery. In addition, the anesthetic protocol decreased side effects and sedation 24 h after surgery compared to patients who underwent general anesthesia only. IL-6 levels increased after the surgery compared to baseline levels in both groups, and no differences in IL-10 and IL-1 beta levels were observed. Our protocol improved the outcomes of mastectomy, which highlight the importance of improving mastectomy protocols and focusing on the benefits of regional anesthesia.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
CONSORT flowchart of the surgeries performed during study development. GA: general anesthesia.
Figure 2
Figure 2
Pain and side effects measured in both groups: general anesthesia (N = 24) and general anesthesia with SAM block + PECS I (N = 25). (A) Pain levels measured using the Visual Analog Scale (VAS) at baseline, in the post-anesthetic care unit (PACU) and 24 h after surgery. (B) Percentages of side effects during the recovery period in the PACU. (C) Percentages of side effects 24 h after the anesthetic procedure. The data are presented as the mean ± standard deviation. *p < 0.05 compared to the general anesthesia only group. #p < 0.05 compared to baseline.
Figure 3
Figure 3
Amounts of drugs used during the surgical procedures in both groups: general anesthesia only (N = 24) and general anesthesia with SAM block + PECS I (N = 25). (A) Fentanyl consumption (mcg). (B) Propofol consumption (mg). (C) Amount of morphine (mg) consumed by the patients in both groups in the post-anesthetic care unit (PACU) and 24 hours after the anesthetic procedure. The data are presented as the mean ± standard deviation. *p < 0.05 compared to the general anesthesia only group.
Figure 4
Figure 4
Quantification of serum cytokine levels (pg/mL) in the patients of both groups: general anesthesia only (N = 24) and general anesthesia with SAM block + PECS I (N = 25) at baseline and 24 h after the anesthetic procedure. (A) IL-6. (B) IL-10. (C) IL-1 beta. The data are presented as the means ± standard error. #p < 0.05 compared to baseline.

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