Clinical Application of Ultrasound-guided Thoracic Nerve Block in the Operation of Benign Breast Tumors

Overview

Journal Am J Transl Res

Specialty General Medicine

Date 2023 Jun 12

PMID 37303624

Authors

Yan Quan

Yinhua Liu

Gang Li

Zhongyu Liu

Affiliations

Soon will be listed here.

Abstract

Objective: To analyze the application of ultrasound-guided thoracic nerve block (TNB) in the operation of benign breast tumors.

Methods: A retrospective analysis was conducted on 69 patients who underwent resection of benign breast tumors (fibroma, segment) in the Maternity and Child Care Center of Qinhuangdao from January 2021 to June 2022. Among them, 33 patients who received TNB were assigned to an observation group, and 36 patients who received local infiltration anesthesia were assigned to a control group. The heart rate (HR) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) of patients were recorded before anesthesia (T0), at skin incision (T1), at 0.5 h after operation (T2) and before leaving the operating room (T3). We also recorded the operation indexes, comprising operation time, total propofol dosage administered during operation, anesthesia recovery time and extubation time. The visual analogue scale (VAS) score was evaluated at 0.5, 2, 4 and 6 h after the operation. The two groups were also compared in terms of the levels of immunoglobulin (Ig) A, IgG, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). The postoperative adverse reactions in the two groups were statistically analyzed.

Results: Compared with the observation group, the control group experienced a longer operation time, anesthesia recovery time and extubation time and consumed more propofol (P < 0.001). At T0 and T1, the two groups were not notably different in SBP, DBP and HR (P > 0.05), but at T2 and T3, the control group showed higher SBP, DBP and HR than the observation group (P < 0.001). The control group exhibited notably higher VAS scores than the observation group (P < 0.001). Before operation, the differences in the levels of IgA, IgG, IL-6 and TNF-α were not significantly different between the two groups (P > 0.05), while after operation and at 24 h after operation, the control group showed higher levels of IgA, IgG, IL-6 and TNF-α in comparison to the observation group (P < 0.01). The incidences of adverse reactions were not significantly different between the two groups (P > 0.05).

Conclusion: Ultrasound-guided TNB can substantially reduce both the operation time and the postoperative pain in patients with benign breast tumors, without increasing the incidence of adverse reactions.

Citing Articles

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PMID: 39347538 PMC: 11439347. DOI: 10.2147/DDDT.S493578.

References

Merino Bonilla J, Torres Tabanera M, Ros Mendoza L . Breast cancer in the 21st century: from early detection to new therapies. Radiologia. 2017; 59(5):368-379. DOI: 10.1016/j.rx.2017.06.003. View

Dos Santos Rodrigues da Silva M, Ferreira M, Fernandez Gacio M, Miranda M, Agrelo A . The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient. Rev Esp Anestesiol Reanim (Engl Ed). 2021; 68(6):338-345. DOI: 10.1016/j.redare.2020.11.004. View

Roman M, Louro J, Posso M, Alcantara R, Penalva L, Sala M . Breast density, benign breast disease, and risk of breast cancer over time. Eur Radiol. 2021; 31(7):4839-4847. DOI: 10.1007/s00330-020-07490-5. View

Cho T, Kim S, O J, Kwon H, Kim K, Yang H . Anatomy of the thoracic paravertebral space: 3D micro-CT findings and their clinical implications for nerve blockade. Reg Anesth Pain Med. 2021; 46(8):699-703. DOI: 10.1136/rapm-2021-102588. View

Mercado C . BI-RADS update. Radiol Clin North Am. 2014; 52(3):481-7. DOI: 10.1016/j.rcl.2014.02.008. View

Li Y, Qin Y, Tang L, Liao Y, Zhang W, Xie X . Patient and Care Delays of Breast Cancer in China. Cancer Res Treat. 2018; 51(3):1098-1106. PMC: 6639234. DOI: 10.4143/crt.2018.386. View

Huang W, Wang W, Xie W, Chen Z, Liu Y . Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis. J Clin Anesth. 2020; 66:109900. DOI: 10.1016/j.jclinane.2020.109900. View

Moynihan A, Quinn E, Smith C, Stokes M, Kell M, Barry J . Benign breast papilloma: Is surgical excision necessary?. Breast J. 2019; 26(4):705-710. DOI: 10.1111/tbj.13642. View

Wijayasinghe N, Duriaud H, Kehlet H, Andersen K, Anderson K . Ultrasound Guided Intercostobrachial Nerve Blockade in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study. Pain Physician. 2016; 19(2):E309-18. View

10.

Ogunbiyi S, Perry A, Jakate K, Simpson J, George R . Phyllodes tumour of the breast and margins: How much is enough. Can J Surg. 2019; 62(1):E19-E21. PMC: 6351251. DOI: 10.1503/cjs.005718. View

11.

Roue C, Wallaert M, Kacha M, Havet E . Intercostal/paraspinal nerve block for thoracic surgery. Anaesthesia. 2015; 71(1):112-3. DOI: 10.1111/anae.13358. View

12.

Katsura C, Ogunmwonyi I, Kankam H, Saha S . Breast cancer: presentation, investigation and management. Br J Hosp Med (Lond). 2022; 83(2):1-7. DOI: 10.12968/hmed.2021.0459. View

13.

Ciftci B, Ekinci M, Basim P, Celik E, Tukac I, Zenciroglu M . Comparison of Ultrasound-Guided Type-II Pectoral Nerve Block and Rhomboid Intercostal Block for Pain Management Following Breast Cancer Surgery: A Randomized, Controlled Trial. Pain Pract. 2021; 21(6):638-645. DOI: 10.1111/papr.13004. View

14.

Zhang W, Cong X, Zhang L, Sun M, Li B, Geng H . Effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery. Clin Transl Med. 2020; 10(3):e38. PMC: 7418816. DOI: 10.1002/ctm2.38. View

15.

Ma H, Tian R, Li H, Sun H, Lu G, Liu R . Fus2Net: a novel Convolutional Neural Network for classification of benign and malignant breast tumor in ultrasound images. Biomed Eng Online. 2021; 20(1):112. PMC: 8600702. DOI: 10.1186/s12938-021-00950-z. View

16.

DErcole F, Arora H, Kumar P . Paravertebral Block for Thoracic Surgery. J Cardiothorac Vasc Anesth. 2017; 32(2):915-927. DOI: 10.1053/j.jvca.2017.10.003. View

17.

Ameli F, Ghafourina Nassab F, Masir N, Kahtib F . Tumor-Derived Matrix Metalloproteinase-13 (MMP-13) Expression in Benign and Malignant Breast Lesions. Asian Pac J Cancer Prev. 2021; 22(8):2603-2609. PMC: 8629480. DOI: 10.31557/APJCP.2021.22.8.2603. View

18.

Gou W, Zhao J, Zhang R, Yang T, Wang L, Zhang X . A menopause survey of women with benign breast disease history in northwest China. Climacteric. 2019; 22(6):622-626. DOI: 10.1080/13697137.2019.1611760. View

19.

Tay T, Tan P . Papillary neoplasms of the breast-reviewing the spectrum. Mod Pathol. 2021; 34(6):1044-1061. DOI: 10.1038/s41379-020-00732-3. View

20.

Yeung J, Gates S, Naidu B, Wilson M, Smith F . Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016; 2:CD009121. PMC: 7151756. DOI: 10.1002/14651858.CD009121.pub2. View