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Comparison of general anesthesia and monitored anesthesia care in patients undergoing breast cancer surgery using a combination of ultrasound-guided thoracic paravertebral block and local infiltration anesthesia: a retrospective study

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Abstract

Purpose

The aim of this study was to compare post-anesthesia recovery time and the incidence of hypotension episodes during anesthesia in breast cancer surgery between general anesthesia (GA) and monitored anesthesia care (MAC) retrospectively. Both techniques were combined with ultrasound-guided paravertebral block (US-PVB) and local infiltration anesthesia (LIA).

Methods

We reviewed the medical records of patients who received US-PVB for breast cancer surgery retrospectively and divided them into two groups based on the method of anesthetic management. In the GA group, anesthesia was induced using propofol and maintained by sevoflurane inhalation via a laryngeal mask airway after US-PVB was performed under sedation with midazolam. In the MAC group, US-PVB and surgery were carried out under sedation with propofol and remifentanil and supplemental oxygen through a facemask. All patients in both groups breathed spontaneously and received US-PVB and LIA with 0.5 % ropivacaine and diclofenac suppository for pain relief.

Results

Times from post-anesthesia care unit admission to fluid intake (mean ± SD; 79 ± 34 vs. 99 ± 33 min, P = 0.034) and gait (77 ± 45 vs. 109 ± 45 min, P = 0.013) were significantly shorter in the MAC group (n = 29) than in the GA group (n = 29). Average systolic blood pressure (SBP) was significantly lower (89 ± 11 vs. 99 ± 16 mmHg, P = 0.011) and the incidence of hypotension (SBP < 70 mmHg) was higher (52 vs. 21 %, P = 0.014) in the GA group than in the MAC group during anesthesia.

Conclusion

MAC with US-PVB and LIA exhibited faster post-anesthesia recovery and a lower incidence of hypotension episodes during anesthesia than GA with US-PVB and LIA in breast cancer surgery.

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Acknowledgments

We thank the nursing staff in DSU at Kyoto University Hospital for data entry.

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Authors and Affiliations

  1. Day Surgery Unit, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan

    Masami Sato

  2. Department of Anesthesia and Pain Medicine, Kagawa University Hospital, Kagawa, 761-0793, Japan

    Gotaro Shirakami

  3. Department of Anesthesia, Kyoto University Hospital, Kyoto, 606-8507, Japan

    Kazuhiko Fukuda

Authors
  1. Masami Sato
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  2. Gotaro Shirakami
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  3. Kazuhiko Fukuda
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Corresponding author

Correspondence to Masami Sato.

Additional information

This work was presented in part at the 56th Congress of the Japanese Society of Anesthesiologists in Kobe and at the International Symposium on Spine and Paravertebral Sonography for Anesthesia and Pain Medicine 2010 in Hong Kong.

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Sato, M., Shirakami, G. & Fukuda, K. Comparison of general anesthesia and monitored anesthesia care in patients undergoing breast cancer surgery using a combination of ultrasound-guided thoracic paravertebral block and local infiltration anesthesia: a retrospective study . J Anesth 30, 244–251 (2016). https://doi.org/10.1007/s00540-015-2111-z

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  • DOI: https://doi.org/10.1007/s00540-015-2111-z

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