Abstract
Non-obstetric surgery is needed in 0.75–2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be approached in a short time interval, and surgery must be performed during pregnancy . In these cases, the technique of anesthesia regarding local, regional or general anesthesia and type of anesthetic medicine are selected based on the extent of the procedure, gestational age, and condition of the mother and child. The ideal timing for any surgery during pregnancy is in the second trimester because the risk of fetal adverse effects as well as preterm labor are lower. However, surgery of breast cancer during pregnancy is performed in any trimester as guided by treatment guidelines and is not deferred based on anesthesia preferences. Various types of anesthesia for breast surgery during pregnancy , preoperative and postoperative considerations are discussed in this chapter.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kuczkowski KM (2004) Nonobstetric surgery during pregnancy: what are the risks of anesthesia? Obstet Gynecol Surv 59(1):52–56
Reitman E, Flood P (2011) Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth 107(suppl 1):i72–i78
Sherwin A, Buggy D (2018) Anaesthesia for breast surgery. BJA Edu 18(11):342–8.0
Van De Velde M, De Buck F (2007) Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol 73(4):235–240
Karvandian K, Zebardast J, Borra NZ (2018) Risk assessment and anesthesia classification in breast cancer surgery. Arch Breast Cancer 5:168–172
Carlson GW (2005) Total mastectomy under local anesthesia: the tumescent technique. Breast J 11(2):100–102
Kitowski NJ, Landercasper J, Gundrum JD, De Maiffe BM, Chestnut DH, Bottcher ML et al (2010) Local and paravertebral block anesthesia for outpatient elective breast cancer surgery. Arch Surg 145(6):592–594
Devereux D (1987) Successful treatment of stages IIIa and IIIb carcinoma of the breast by mastectomy in the elderly high risk patient using local anesthesia. Surg Gynecol Obstet 165(1):38–40
Markose G, Graham RM (2017) Anaesthesia: LA in pregnancy. Br Dent J 222(1):3–4
Hagai A, Diav-Citrin O, Shechtman S, Ornoy A (2015) Pregnancy outcome after in utero exposure to local anesthetics as part of dental treatment: a prospective comparative cohort study. J Am Dent Assoc 146(8):572–580
Fayans EP, Stuart HR, Carsten D, Ly Q, Kim H (2010) Local anesthetic use in the pregnant and postpartum patient. Dental Clinic 54(4):697–713
Atanassoff PG, Alon E, Weiss BM (1994) Intercostal nerve block for lumpectomy: superior postoperative pain relief with bupivacaine. J Clin Anesth 6(1):47–51
Greengrass R, O’brien F, Lyerly K, Hardman D, Gleason D, D’Ercole F et al (1996) Paravertebral block for breast cancer surgery. Can J Anaesth 43(8):858–861
Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E (1999) Single-injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand 43(7):770–774
Levene JL, Weinstein EJ, Cohen MS, Andreae DA, Chao JY, Johnson M et al (2019) Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: a Cochrane systematic review and meta-analysis update. J Clin Anesth 55:116–127
Tahiri Y, Tran DQ, Bouteaud J, Xu L, Lalonde D, Luc M et al (2011) General anaesthesia versus thoracic paravertebral block for breast surgery: a meta-analysis. J Plast Reconstr Aesthet Surg 64(10):1261–1269
Blanco R (2011) The ‘pecs block:’ a novel technique for providing analgesia after breast surgery. Anaesthesia 66(9):847–848
Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ (1995) Thoracic epidural anesthesia improves outcome after breast surgery. Ann Surg 222(5):663–669
Cali Cassi L, Biffoli F, Francesconi D, Petrella G, Buonomo O (2017) Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block. Eur Rev Med Pharmacol Sci 21(6):1341–1345
Abdallah FW, Morgan PJ, Cil T, McNaught A, Escallon JM, Semple JL et al (2014) Ultrasound-guided multilevel paravertebral blocks and total intravenous anesthesia improve the quality of recovery after ambulatory breast tumor resection. Anesthesiology 120(3):703–713
Coveney E, Weltz CR, Greengrass R, Iglehart JD, Leight GS, Steele SM et al (1998) Use of paravertebral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Ann Surg 227(4):496–501
Najarian MM, Johnson JM, Landercasper J, Havlik P (2003) Paravertebral block: an alternative to general anesthesia in breast cancer surgery/discussion. Am Surg 69(3):213–218
Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA (2000) Thoracic paravertebral block for breast surgery. Anesth Analg 90(6):1402–1405
Terheggen MA, Wille F, Rinkes IHB, Ionescu TI, Knape JT (2002) Paravertebral blockade for minor breast surgery. Anesth Analg 94(2):355–359
Kuczkowski KM (2006) The safety of anaesthetics in pregnant women. Expert Opin Drug Saf 5(2):251–264
Ravindra G, Madamangalam AS, Seetharamaiah S (2018) Anaesthesia for non-obstetric surgery in obstetric patients. Indian J Anaesth 62(9):710–716
Hayashi T, Katayama M, Miyasaka K (2013) General anesthesia for breast cancer surgery during pregnancy: a retrospective review at a breast cancer center in Tokyo between 1999–2011: 11AP5-2. Eur J Anaesthesiol 30:178
Rybstein MD, DeSancho MT (2019) Risk factors for and clinical management of venous thromboembolism during pregnancy. Risk 17(7):396–404
Omarini C, Guaitoli G, Noventa S, Andreotti A, Gambini A, Palma E et al (2017) Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients. Eur J Surg Oncol 43(4):613–618
Sanford RA, Lei X, Barcenas CH, Mittendorf EA, Caudle AS, Valero V et al (2016) Impact of time from completion of neoadjuvant chemotherapy to surgery on survival outcomes in breast cancer patients. Ann Surg Oncol 23(5):1515–1521
Pitman A, Suleman S, Hyde N, Hodgkiss A (2018) Depression and anxiety in patients with cancer. BMJ 361:k1415
Walker AJ, Card TR, West J, Crooks C, Grainge MJ (2013) Incidence of venous thromboembolism in patients with cancer–a cohort study using linked United Kingdom databases. Eur J Cancer 49(6):1404–1413
Horsted F, West J, Grainge MJ (2012) Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med 9(7):e1001275
Walker AJ, West J, Card TR, Crooks C, Kirwan CC, Grainge MJ (2016) When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data. Blood 127(7):849–857
Cronin-Fenton DP, Søndergaard F, Pedersen L, Fryzek J, Cetin K, Acquavella J et al (2010) Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997–2006. Br J Cancer 103(7):947–953
Meier CR, Jick H (1998) Tamoxifen and risk of idiopathic venous thromboembolism. Br J Clin Pharmacol 45(6):608–612
Xu X, Chlebowski RT, Shi J, Barac A, Haque R (2019) Aromatase inhibitor and tamoxifen use and the risk of venous thromboembolism in breast cancer survivors. Breast Cancer Res Treat 174(3):785–794
Heery M, Corbett P, Zelkowitz R (2018) Precautions for patients taking tamoxifen. J Adv Pract Oncol 9(1):78–83
Parikh RP, Odom EB, Yu L, Colditz GA, Myckatyn TM (2017) Complications and thromboembolic events associated with tamoxifen therapy in patients with breast cancer undergoing microvascular breast reconstruction: a systematic review and meta-analysis. Breast Cancer Res Treat 163(1):1–10
Hussain T, Kneeshaw PJ (2012) Stopping tamoxifen peri-operatively for VTE risk reduction: a proposed management algorithm. Int J Surg 10(6):313–316
Mhuireachtaigh RN, O’Gorman DA (2006) Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth 18(1):60–66
Lamvu G, Feranec J, Blanton E (2018) Perioperative pain management: an update for obstetrician-gynecologists. Am J Obstet Gynecol 218(2):193–199
Stewart MK, Terhune KP (2015) Management of pregnant patients undergoing general surgical procedures. Surg Clin North Am 95(2):429–442
Pannucci CJ, Shanks A, Moote MJ, Bahl V, Cederna PS, Naughton NN et al (2012) Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery. Ann Surg 255(6):1093–1099
Collins J, Bowles L, MacCallum PK (2016) Prevention and management of venous thromboembolism in pregnancy. Br J Hosp Med 77(12):C194–C200
ACOG Practice Bulletin No. 196 (2018) Thromboembolism in pregnancy. Obstet Ggynecol 132(1):e1–e17
Heaney A, Buggy DJ (2012) Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? Br J Anaesth 109(suppl-1):i17–i28
Garg R (2017) Regional anaesthesia in breast cancer: benefits beyond pain. Ind J Aanaesth 61(5):369–372
Ni Eochagain A, Burns D, Riedel B, Sessler DI, Buggy DJ (2018) The effect of anaesthetic technique during primary breast cancer surgery on neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and return to intended oncological therapy. Anaesthesia 73(5):603–611
Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI (2006) Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology 105(4):660–664
Buckley A, McQuaid S, Johnson P, Buggy DJ (2014) Effect of anaesthetic technique on the natural killer cell anti-tumour activity of serum from women undergoing breast cancer surgery: a pilot study. Br J Anaesth 113(suppl-1):i56–i62
Matsumoto M, Flores EM, Kimachi PP, Gouveia FV, Kuroki MA, Barros ACSD et al (2018) Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia. Sci Rep 8(1):7815
Kairaluoma P, Mattson J, Heikkilä P, Pere P, Leidenius M (2016) Perioperative paravertebral regional anaesthesia and breast cancer recurrence. Anticancer Res 36(1):415–418
Finn DM, Ilfeld BM, Unkart JT, Madison SJ, Suresh PJ, Sandhu NPS et al (2017) Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation. J Anesth 31(3):374–379
Starnes-Ott K, Goravanchi F, Meininger JC (2015) Anesthetic choices and breast cancer recurrence: a retrospective pilot study of patient, disease, and treatment factors. Crit Care Nurs Q 38(2):200–210
Sessler DI, Pei L, Huang Y, Fleischmann E, Marhofer P, Kurz A, Mayers DB, Meyer-Treschan TA, Grady M, Tan EY, Ayad S (2019) Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial. Lancet 394(10211):1807–1815
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Eskandari, A., Alipour, S. (2020). Aspects of Anesthesia for Breast Surgery during Pregnancy. In: Alipour, S., Omranipour, R. (eds) Diseases of the Breast during Pregnancy and Lactation. Advances in Experimental Medicine and Biology, vol 1252. Springer, Cham. https://doi.org/10.1007/978-3-030-41596-9_14
Download citation
DOI: https://doi.org/10.1007/978-3-030-41596-9_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-41595-2
Online ISBN: 978-3-030-41596-9
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)