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Kudriavtsev A, Pastor B, Mirandola A, Pisareva E, Gricourt Y, Capdevila X, Thierry AR, Cuvillon P. Association of the immediate perioperative dynamics of circulating DNA levels and neutrophil extracellular traps formation in cancer patients. PRECISION CLINICAL MEDICINE 2024; 7:pbae008. [PMID: 38699382 PMCID: PMC11062027 DOI: 10.1093/pcmedi/pbae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives Elevated circulating DNA (cirDNA) concentrations were found to be associated with trauma or tissue damage which suggests involvement of inflammation or cell death in post-operative cirDNA release. We carried out the first prospective, multicenter study of the dynamics of cirDNA and neutrophil extracellular trap (NETs) markers during the perioperative period from 24 h before surgery up to 72 h after curative surgery in cancer patients. Methods We examined the plasma levels of two NETs protein markers [myeloperoxidase (MPO) and neutrophil elastase (NE)], as well as levels of cirDNA of nuclear (cir-nDNA) and mitochondrial (cir-mtDNA) origin in 29 colon, prostate, and breast cancer patients and in 114 healthy individuals (HI). Results The synergistic analytical information provided by these markers revealed that: (i) NETs formation contributes to post-surgery conditions; (ii) post-surgery cir-nDNA levels were highly associated with NE and MPO in colon cancer [r = 0.60 (P < 0.001) and r = 0.53 (P < 0.01), respectively], but not in prostate and breast cancer; (iii) each tumor type shows a specific pattern of cir-nDNA and NETs marker dynamics, but overall the pre- and post-surgery median values of cir-nDNA, NE, and MPO were significantly higher in cancer patients than in HI. Conclusion Taken as a whole, our work reveals the association of NETs formation with the elevated cir-nDNA release during a cancer patient's perioperative period, depending on surgical procedure or cancer type. By contrast, cir-mtDNA is poorly associated with NETs formation in the studied perioperative period, which would appear to indicate a different mechanism of release or suggest mitochondrial dysfunction.
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Affiliation(s)
- Andrei Kudriavtsev
- Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Montpellier 34298, France
| | - Brice Pastor
- Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Montpellier 34298, France
- Institut régional du Cancer de Montpellier, Montpellier 34298, France
| | - Alexia Mirandola
- Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Montpellier 34298, France
| | - Ekaterina Pisareva
- Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Montpellier 34298, France
| | - Yann Gricourt
- Department of Anaesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré,Nîmes 30400, France
- University of Montpellier, Montpellier 34298, France
| | - Xavier Capdevila
- Division of Anaesthesia Intensive Care, Pain and Emergency Medicine, Montpellier University Hospital, Montpellier 34090, France
- Montpellier NeuroSciences Institute, INSERM U1298, University of Montpellier, Montpellier 34295, France
| | - Alain R Thierry
- Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Montpellier 34298, France
- Institut régional du Cancer de Montpellier, Montpellier 34298, France
| | - Philippe Cuvillon
- Department of Anaesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré,Nîmes 30400, France
- University of Montpellier, Montpellier 34298, France
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Ou Y, Wu M, Liu D, Luo L, Xu X, Panayi AC, He J, Long Y, Feng J, Nian M, Cui Y. Efficacy and Safety of Nerve Block for Postoperative Analgesia in Patients Undergoing Breast Cosmetic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2024; 48:71-83. [PMID: 36939869 DOI: 10.1007/s00266-023-03320-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/04/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND To evaluate the postoperative analgesic efficacy and safety of nerve block (NB) in patients undergoing breast surgery for cosmetic purposes. METHODS PubMed, Web of Science, Embase and Cochrane Libraries were searched from inception to September 2022, to identify all eligible randomized controlled trials (RCTs). Continuous data are presented as mean difference (MD) with 95% confidence intervals (CI), whereas dichotomous data are provided as odds ratios (OR) with 95% CI. This meta-analysis was performed in RevMan 5.4. RESULTS A total of 10 RCTs with 565 patients were meta-analyzed. Compared to the control group, the pain score of the NB group was significantly lower at postoperative 2, 3-4, 6-8, 12-16 and 24 h. Opioid consumption in the first postoperative 24 h was significantly lower in the NB group (MD = - 9.02, 95% CI - 14.29 to - 3.75, P < 0.05), I2 = 95%). In addition, the NB group showed a prolonged time to first postoperative analgesic requirement (MD = 43.15, 95% CI 4.74-81.56, P < 0.05, I2 = 96%), decreased incidence of additional postoperative analgesia (OR 0.14, 95% CI 0.07-0.28, P < 0.05, I2 = 0%) and reduced incidence of postoperative nausea or vomiting (OR 0.33; 95% CI 0.22-0.48; P < 0.05; I2 = 0%). There was no significant difference in operation duration between the two groups. CONCLUSIONS Nerve block is an effective and safe option for postoperative analgesia after breast cosmetic surgery. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yanting Ou
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Mengfan Wu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Dandan Liu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Lin Luo
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Xiangwen Xu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Junjun He
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yun Long
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Jun Feng
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Mingxuan Nian
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Yongyan Cui
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China.
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Tokita HK, Assel M, Simon BA, Lin E, Sarraf L, Masson G, Pilewskie M, Vingan P, Vickers A, Nelson JA. Regional Blocks Benefit Patients Undergoing Bilateral Mastectomy with Immediate Implant-Based Reconstruction, Even After Discharge. Ann Surg Oncol 2024; 31:316-324. [PMID: 37747581 PMCID: PMC11200308 DOI: 10.1245/s10434-023-14348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND There is limited evidence that regional anesthesia reduces pain in patients undergoing mastectomy with immediate implant-based reconstruction. We sought to determine whether regional blocks reduce opioid consumption and improve post-discharge patient-reported pain in this population. METHODS We retrospectively reviewed patients who underwent bilateral mastectomy with immediate implant-based reconstruction with and without a regional block. We tested for differences in opioid consumption by block receipt using multivariable ordinal regression, and also assessed routinely collected patient-reported outcomes (PROs) for 10 days postoperatively and tested the association between block receipt and moderate or greater pain. RESULTS Of 754 patients, 89% received a block. Non-block patients had an increase in the odds of requiring a higher quartile of postoperative opioids. Among block patients, the estimated probability of being in the lowest quartile of opioids required was 25%, compared with 15% for non-block patients. Odds of patient-reported moderate or greater pain after discharge was 0.54 times lower in block patients than non-block patients (p = 0.025). Block patients had a 49% risk of moderate or greater pain compared with 64% in non-block patients on postoperative day 5. There was no indication of any reason for these differences other than a causal effect of the block. CONCLUSION Receipt of a regional block resulted in reduced opioid use and lower risk of self-reported moderate and higher pain after discharge in bilateral mastectomy with immediate implant-based reconstruction patients. Our use of PROs suggests that the analgesic effects of blocks persist after discharge, beyond the expected duration of a 'single shot' block.
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Affiliation(s)
- Hanae K Tokita
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Melissa Assel
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett A Simon
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily Lin
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leslie Sarraf
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Geema Masson
- Department of Anesthesiology and Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Perri Vingan
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Vickers
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Yang H, Wang H, Wang Q. The analgesic efficacy of pectoral nerve block for breast augmentation: a meta-analysis of randomized controlled studies. J Plast Surg Hand Surg 2023; 58:142-148. [PMID: 38095482 DOI: 10.2340/jphs.v58.9395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/18/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Many patients suffered from serious pain after breast augmentation, but the analgesic efficacy of pectoral nerve block for these patients was not well established. Thus, this meta-analysis was intended to study the analgesic efficacy of pectoral nerve block for breast augmentation. METHODS Several databases including PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases were searched, and we included randomized controlled trials (RCTs) regarding the analgesic efficacy of pectoral nerve block for breast augmentation. RESULTS Six RCTs were ultimately included in this meta-analysis. Compared with control intervention for breast augmentation, pectoral nerve block could significantly reduce pain scores at 1 h (mean difference [MD] = -2.28; 95% confidence interval [CI] = -3.71 to -0.85; P = 0.002), 2 h (MD = -3.08; 95% CI = -3.95 to -2.20; P < 0.00001), 4 h (MD = -2.95; 95% CI = -3.32 to -2.58; P < 0.00001), 6-8 h (MD = -2.68; 95% CI = -3.24 to -2.11; P < 0.00001), 24 h (MD = -2.04; 95% CI = -2.41 to -1.67; P < 0.00001), the number of analgesic requirement (odd ratio [OR] = 0.20; 95% CI = 0.09 to 0.45; P = 0.0001), and the incidence of nausea (OR = 0.21; 95% CI = 0.08 to 0.54; P = 0.001) and vomiting (OR = 0.15; 95% CI = 0.05 to 0.39; P = 0.0001). Conclusions: Pectoral nerve block may be effective for pain relief after breast augmentation.
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Affiliation(s)
- Hailin Yang
- Department of thoracic and thyroid breast surgery, The People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Hao Wang
- Department of thoracic and thyroid breast surgery, The People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Qi Wang
- Department of thoracic and thyroid breast surgery, The People's Hospital of Yubei District of Chongqing City, Chongqing, China.
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Chai B, Du J, Chen T, Yu H, Feng Z, Kang X. A Response to: Letter to the Editor Regarding "Role of Serratus Anterior Plane Block in Breast Surgeries". Pain Ther 2023; 12:1105-1107. [PMID: 37300739 PMCID: PMC10290014 DOI: 10.1007/s40122-023-00523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023] Open
Affiliation(s)
- Binggao Chai
- Department of Anesthesiology, Tongxiang First People's Hospital, Zhejiang, China
| | - Jianlong Du
- Department of Anesthesiology, Tongxiang First People's Hospital, Zhejiang, China
| | - Tao Chen
- Department of Anesthesiology, Tongxiang First People's Hospital, Zhejiang, China
| | - Hongmei Yu
- Department of Breast Surgery, Tongxiang First People's Hospital, Zhejiang, China
| | - Zhiying Feng
- Department of Pain, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Xianhui Kang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Liang Z, Xu Y. The efficacy of pectoral nerve block for pain control after breast augmentation: A meta-analysis of randomized controlled studies. Medicine (Baltimore) 2023; 102:e32863. [PMID: 36827054 PMCID: PMC11309730 DOI: 10.1097/md.0000000000032863] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The efficacy of pectoral nerve block for pain control remains unknown in patients undergoing breast augmentation. This meta-analysis aims to explore the analgesic efficacy of pectoral nerve block for breast augmentation. METHODS We systematically searched PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases, and included randomized controlled trials reporting pectoral nerve block versus no block for breast augmentation. RESULTS Five randomized controlled trials were included in this meta-analysis. Compared with control group after breast augmentation, pectoral nerve block was associated with substantially reduced pain scores at 1 hour (standard mean difference [SMD] = -1.63; 95% confidence interval [CI] = -2.81 to -0.44; P = .007), maximal pain scores at 1 to 6 hours (SMD = -1.72; 95% CI = -2.75 to -0.69; P = .001) and 6 to 24 hours (SMD = -2.06; 95% CI = -3.40 to -0.72; P = .003), rescue analgesic (odd ratio = 0.17; 95% CI = 0.05-0.57; P = .004), nausea (SMD = 0.21; 95% CI = 0.08-0.54; P = .001), and vomiting (odd ratio = 0.15; 95% CI = 0.05-0.39; P = .0001). CONCLUSIONS Pectoral nerve block benefits to alleviate pain intensity after breast augmentation.
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Affiliation(s)
| | - Yang Xu
- First Affiliated Hospital of Xiamen University Siming Branch, Xiamen, Fujian Province, China
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7
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Pectoral Nerve Blocks for Breast Augmentation Surgery: Comment. Anesthesiology 2023; 138:221-222. [PMID: 36534914 DOI: 10.1097/aln.0000000000004451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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8
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Pectoral Nerve Blocks for Breast Augmentation Surgery: Comment. Anesthesiology 2023; 138:220-221. [PMID: 36534907 DOI: 10.1097/aln.0000000000004450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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9
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van der Wal I, Meijer F, Fuica R, Silman Z, Boon M, Martini C, van Velzen M, Dahan A, Niesters M, Gozal Y. Intraoperative use of the machine learning-derived nociception level monitor results in less pain in the first 90 min after surgery. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1086862. [PMID: 36700141 PMCID: PMC9869062 DOI: 10.3389/fpain.2022.1086862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023]
Abstract
In this pooled analysis of two randomized clinical trials, intraoperative opioid dosing based on the nociception level-index produced less pain compared to standard care with a difference in pain scores in the post-anesthesia care unit of 1.5 (95% CI 0.8-2.2) points on an 11-point scale. The proportion of patients with severe pain was lower by 70%. Severe postoperative pain remains a significant problem and associates with several adverse outcomes. Here, we determined whether the application of a monitor that detects intraoperative nociceptive events, based on machine learning technology, and treatment of such events reduces pain scores in the post-anesthesia care unit (PACU). To that end, we performed a pooled analysis of two trials in adult patients, undergoing elective major abdominal surgery, on the effect of intraoperative nociception level monitor (NOL)-guided fentanyl dosing on PACU pain was performed. Patients received NOL-guided fentanyl dosing or standard care (fentanyl dosing based on hemodynamic parameters). Goal of the intervention was to keep NOL at values that indicated absence of nociception. The primary endpoint of the study was the median pain score obtained in the first 90 min in the PACU. Pain scores were collected at 15 min intervals on an 11-point Likert scale. Data from 125 patients (55 men, 70 women, age range 21-86 years) were analyzed. Sixty-one patients received NOL-guided fentanyl dosing and 64 standard care. Median PACU pain score was 1.5 points (0.8-2.2) lower in the NOL group compared to the standard care; the proportion of patients with severe pain was 70% lower in the NOL group (p = 0.045). The only significant factor associated with increased odds for severe pain was the standard of care compared to NOL treatment (OR 6.0, 95% CI 1.4 -25.9, p = 0.017). The use of a machine learning-based technology to guide opioid dosing during major abdominal surgery resulted in reduced PACU pain scores with less patients in severe pain.
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Affiliation(s)
- Imeen van der Wal
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Fleur Meijer
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Rivka Fuica
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Zmira Silman
- Independent Biostatistician Consultant, Netanya, Israel
| | - Martijn Boon
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Chris Martini
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique van Velzen
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands,Correspondence: Albert Dahan
| | - Marieke Niesters
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Yaacov Gozal
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel
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Reduced postoperative pain in patients receiving nociception monitor guided analgesia during elective major abdominal surgery: a randomized, controlled trial. J Clin Monit Comput 2022; 37:481-491. [PMID: 35976578 PMCID: PMC9383658 DOI: 10.1007/s10877-022-00906-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/28/2022] [Indexed: 11/04/2022]
Abstract
The Nociception Level index (NOL™) is a multiparameter index, based on artificial intelligence for the monitoring of nociception during anesthesia. We studied the influence of NOL-guided analgesia on postoperative pain scores in patients undergoing major abdominal surgery during sevoflurane/fentanyl anesthesia. This study was designed as a single-center, prospective randomized, controlled study. After Institutional Review Board approval and written informed consent, 75 ASA 1–3 adult patients undergoing major abdominal surgery, were randomized to NOL-guided fentanyl dosing (NOL) or standard care (SOC) and completed the study. The sevoflurane target MAC range was 0.8–1.2. In the NOL-guided group (N = 36), when NOL values were > 25 for at least 1 min, a weight adjusted fentanyl bolus was administered. In the control group (N = 39) fentanyl administration was based on hemodynamic indices and clinician judgement. After surgery, pain, was evaluated using the Numerical Rating Scale (NRS) pain scale, ranging from 0 to 10, at 15 min intervals for 180 min or until patient discharge from the PACU. Median postoperative pain scores reported were 3.0 [interquartile range 0.0–5.0] and 5.0 [3.0–6.0] at 90 min in NOL-guided and control groups respectively (Bootstrap corrected actual difference 1.5, 95% confidence interval 0.4–2.6). There was no difference in postoperative morphine consumption or intraoperative fentanyl consumption. Postoperative pain scores were significantly improved in nociception level index-guided patients. We attribute this to more objective fentanyl dosing when timed to actual nociceptive stimuli during anesthesia, contributing to lower levels of sympathetic activation and surgical stress. Clinicaltrials.gov identifier: NCT03970291 date of registration May 31, 2019.
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Uribe AA, Weaver TE, Echeverria-Villalobos M, Periel L, Pasek J, Fiorda-Diaz J, Palettas M, Skoracki RJ, Poteet SJ, Heard JA. Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study. Front Med (Lausanne) 2022; 9:975080. [PMID: 36045918 PMCID: PMC9420942 DOI: 10.3389/fmed.2022.975080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Pectoralis nerve blocks (PECS) have been shown in numerous studies to be a safe and effective method to treat postoperative pain and reduce postoperative opioid consumption after breast surgery. However, there are few publications evaluating the PECS block effectiveness in conjunction with multimodal analgesia (MMA) in outpatient breast surgery. This retrospective study aims to evaluate the efficacy of PECS's blocks on perioperative pain management and opioid consumption. Methods We conducted a retrospective study to assess the efficacy of preoperative PECS block in addition to preoperative MMA (oral acetaminophen and/or gabapentin) in reducing opioid consumption in adult female subjects undergoing outpatient elective breast surgery between 2015 and 2020. A total of 228 subjects were included in the study and divided in two groups: PECS block group (received PECS block + MMA) and control Group (received only MMA). The primary outcome was to compare postoperative opioid consumption between both groups. The secondary outcome was intergroup comparisons of the following: postoperative nausea and vomiting (PONV), incidence of rescue antiemetic medication, PACU non-opioid analgesic medication required, length of PACU stay and the incidence of 30-day postoperative complications between both groups. Results Two hundred and twenty-eight subjects (n = 228) were included in the study. A total of 174 subjects were allocated in the control group and 54 subjects were allocated in the PECS block group. Breast reduction and mastectomy/lumpectomy surgeries were the most commonly performed procedures (48% and 28%, respectively). The total amount of perioperative (intraoperative and PACU) MME was 27 [19, 38] in the control group and 28.5 [22, 38] in the PECS groups (p = 0.21). PACU opioid consumption was 14.3 [7, 24.5] MME for the control group and 17 [8, 23] MME (p = 0.732) for the PECS group. Lastly, the mean overall incidence of postsurgical complications at 30 days was 3% (N = 5), being wound infection, the only complication observed in the PECS groups (N = 2), and hematoma (N = 2) and wound dehiscence (N = 1) in the control group. Conclusion PECS block combined with MMA may not reduce intraoperative and/or PACU opioid consumption in patients undergoing outpatient elective breast surgery.
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Affiliation(s)
- Alberto A. Uribe
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, United States
| | - Tristan E. Weaver
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, United States
| | | | - Luis Periel
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, United States
| | - Joshua Pasek
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, United States
| | - Juan Fiorda-Diaz
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, United States
| | - Marilly Palettas
- Department of Biomedical Informatics, The Ohio State University, Center of Biostatistics, Columbus, OH, United States
| | - Roman J. Skoracki
- Department of Plastic Surgery, The Ohio State University Medical Center, Columbus, OH, United States
| | - Stephen J. Poteet
- Department of Plastic Surgery, The Ohio State University Medical Center, Columbus, OH, United States
| | - Jarrett A. Heard
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, United States
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Chen WX, Xue FS, Li CW. Comparing analgesic efficacy of peripheral nerve blocks with thoracic epidural block after major abdominal cancer surgery: Study design is important. J Surg Oncol 2022; 125:548-549. [PMID: 35038169 DOI: 10.1002/jso.26777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Wen-Xuan Chen
- Sixth Clinical Medical College and Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Cheng-Wen Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Chen WX, Xue FS, Li CW. Assessing Postoperative Benefits of a Nerve Block: Study Design is Critical [Letter]. J Pain Res 2022; 15:39-40. [PMID: 35027846 PMCID: PMC8752072 DOI: 10.2147/jpr.s352469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wen-Xuan Chen
- Sixth Clinical Medical College and Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Cheng-Wen Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Vingan NR, Teitelbaum S, Moorman R, Kenkel JM. Asystolic Cardiac Arrest Associated With Unstable Bradycardia During Augmentation Mammaplasty: A Case Report. Aesthet Surg J Open Forum 2021; 4:ojab047. [PMID: 35072070 PMCID: PMC8781763 DOI: 10.1093/asjof/ojab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiac arrest is a rare but reported complication during breast augmentation surgery. It is even more rare in a reportedly healthy patient without preexisting cardiac disease. The authors present the case of a healthy 34-year-old female who underwent elective bilateral augmentation mammaplasty and experienced unanticipated asystolic cardiac arrest intraoperatively following general anesthesia supplemented by a regional pectoral (pec I) nerve block. The performing plastic surgeon provided cardiopulmonary resuscitation while the anesthesiologist initiated a rescue protocol per Advanced Cardiac Life Support (ACLS) guidelines. Fortunately, the patient was resuscitated in a timely manner and had a successful return of spontaneous circulation within 1 minute. This case report serves to briefly review the literature and recommendations on proper resuscitation of cardiac arrest per ACLS protocols as well as discuss unstable bradycardia in otherwise healthy patients undergoing breast augmentation surgery. Plastic surgeons and anesthesiologists who perform this procedure should be aware of the possible, rare but serious progression to asystole as well as the proper resuscitative measures to take should they be required. LEVEL OF EVIDENCE 5
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Affiliation(s)
- Nicole R Vingan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven Teitelbaum
- associate clinical professor of plastic surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Rita Moorman
- American Board of Anesthesiology in private practice in Santa Monica, CA, USA
| | - Jeffrey M Kenkel
- Corresponding Author: Dr Jeffrey M. Kenkel, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-9132, USA. E-mail:
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