Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases
Paolo Vincenzi,1 Massimo Stronati,2 Paolo Isidori,1 Salvatore Iuorio,2 Diletta Gaudenzi,3 Gianfranco Boccoli,1 Roberto Starnari2 1Department of General Surgery, IRCSS-INRCA, Ancona, Italy; 2Department of Anaesthesiology, IRCSS-INRCA, Ancona, Italy; 3Department of Perioperative Services, AOU “Ospedal...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2022-05-01
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| Series: | Local and Regional Anesthesia |
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| Online Access: | https://www.dovepress.com/opioid-free-segmental-thoracic-spinal-anesthesia-with-intrathecal-seda-peer-reviewed-fulltext-article-LRA |
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| author | Vincenzi P Stronati M Isidori P Iuorio S Gaudenzi D Boccoli G Starnari R |
| author_facet | Vincenzi P Stronati M Isidori P Iuorio S Gaudenzi D Boccoli G Starnari R |
| author_sort | Vincenzi P |
| collection | DOAJ |
| description | Paolo Vincenzi,1 Massimo Stronati,2 Paolo Isidori,1 Salvatore Iuorio,2 Diletta Gaudenzi,3 Gianfranco Boccoli,1 Roberto Starnari2 1Department of General Surgery, IRCSS-INRCA, Ancona, Italy; 2Department of Anaesthesiology, IRCSS-INRCA, Ancona, Italy; 3Department of Perioperative Services, AOU “Ospedali Riuniti di Ancona”, Ancona, ItalyCorrespondence: Paolo Vincenzi, Department of General Surgery, IRCSS-INRCA, Via della Montagnola n 81, Ancona, 60127, Italy, Tel + 39 3394578495, Email paolo.vincenzi1981@gmail.comPurpose: Few studies have described segmental thoracic spinal anesthesia (STSA) as primary anesthesiologic method in breast and axillary surgery, documenting the association of intrathecal local anesthetics and opioids. This case series reports an opioid-free scheme of STSA in four elderly patients undergoing major breast and axillary oncological surgery.Patients and Methods: STSA was performed in three female patients undergoing unilateral mastectomy ± axillary lymph node dissection (ALND) or sentinel lymph node biopsy for invasive ductal carcinoma and in one male patient undergoing ALND for melanoma metastases. The level of needle insertion was included between T6-8, via a median or paramedian approach. Midazolam (2 mg) and ketamine (20 mg) were used as adjuvants for intrathecal sedation, followed by the administration of hypobaric ropivacaine 0.25% at a dose of 8 mg. The level of sensory blockade achieved was comprised between C2-3 and T11-12. Postoperative analgesia was maintained through continuous intravenous administration of Ketorolac by an elastomeric pump (90 mg over 24 hrs.).Results: Spinal anesthesia was completed without complications in all patients. Conversion to general anesthesia (GA) and perioperative intravenous sedation were not required. No major postoperative complications and no episodes of postoperative nausea and vomiting (PONV) were reported. No rescue analgesic was administered. All patients were discharged in postoperative day 2 and are alive at 30, 29, 27 and 13 months after surgery, respectively. High grade of satisfaction on the anesthesiologic method was expressed by all cases.Conclusion: STSA with local anesthetic plus midazolam and ketamine might be considered a safe and effective alternative to GA, even in surgeries involving the breast and axillary region, particularly in elderly and frail patients. Larger prospective studies are required to validate these findings.Keywords: spinal anesthesia, breast cancer surgery, axillary surgery, intrathecal midazolam, intrathecal ketamine |
| first_indexed | 2024-04-13T09:39:51Z |
| format | Article |
| id | doaj.art-7fbb0954c24241ed8c96f25c9a04ba15 |
| institution | Directory Open Access Journal |
| issn | 1178-7112 |
| language | English |
| last_indexed | 2024-04-13T09:39:51Z |
| publishDate | 2022-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Local and Regional Anesthesia |
| spelling | doaj.art-7fbb0954c24241ed8c96f25c9a04ba152022-12-22T02:51:57ZengDove Medical PressLocal and Regional Anesthesia1178-71122022-05-01Volume 15232975155Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four CasesVincenzi PStronati MIsidori PIuorio SGaudenzi DBoccoli GStarnari RPaolo Vincenzi,1 Massimo Stronati,2 Paolo Isidori,1 Salvatore Iuorio,2 Diletta Gaudenzi,3 Gianfranco Boccoli,1 Roberto Starnari2 1Department of General Surgery, IRCSS-INRCA, Ancona, Italy; 2Department of Anaesthesiology, IRCSS-INRCA, Ancona, Italy; 3Department of Perioperative Services, AOU “Ospedali Riuniti di Ancona”, Ancona, ItalyCorrespondence: Paolo Vincenzi, Department of General Surgery, IRCSS-INRCA, Via della Montagnola n 81, Ancona, 60127, Italy, Tel + 39 3394578495, Email paolo.vincenzi1981@gmail.comPurpose: Few studies have described segmental thoracic spinal anesthesia (STSA) as primary anesthesiologic method in breast and axillary surgery, documenting the association of intrathecal local anesthetics and opioids. This case series reports an opioid-free scheme of STSA in four elderly patients undergoing major breast and axillary oncological surgery.Patients and Methods: STSA was performed in three female patients undergoing unilateral mastectomy ± axillary lymph node dissection (ALND) or sentinel lymph node biopsy for invasive ductal carcinoma and in one male patient undergoing ALND for melanoma metastases. The level of needle insertion was included between T6-8, via a median or paramedian approach. Midazolam (2 mg) and ketamine (20 mg) were used as adjuvants for intrathecal sedation, followed by the administration of hypobaric ropivacaine 0.25% at a dose of 8 mg. The level of sensory blockade achieved was comprised between C2-3 and T11-12. Postoperative analgesia was maintained through continuous intravenous administration of Ketorolac by an elastomeric pump (90 mg over 24 hrs.).Results: Spinal anesthesia was completed without complications in all patients. Conversion to general anesthesia (GA) and perioperative intravenous sedation were not required. No major postoperative complications and no episodes of postoperative nausea and vomiting (PONV) were reported. No rescue analgesic was administered. All patients were discharged in postoperative day 2 and are alive at 30, 29, 27 and 13 months after surgery, respectively. High grade of satisfaction on the anesthesiologic method was expressed by all cases.Conclusion: STSA with local anesthetic plus midazolam and ketamine might be considered a safe and effective alternative to GA, even in surgeries involving the breast and axillary region, particularly in elderly and frail patients. Larger prospective studies are required to validate these findings.Keywords: spinal anesthesia, breast cancer surgery, axillary surgery, intrathecal midazolam, intrathecal ketaminehttps://www.dovepress.com/opioid-free-segmental-thoracic-spinal-anesthesia-with-intrathecal-seda-peer-reviewed-fulltext-article-LRAspinal anesthesiabreast cancer surgeryaxillary surgeryintrathecal midazolamintrathecal ketamine |
| spellingShingle | Vincenzi P Stronati M Isidori P Iuorio S Gaudenzi D Boccoli G Starnari R Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases Local and Regional Anesthesia spinal anesthesia breast cancer surgery axillary surgery intrathecal midazolam intrathecal ketamine |
| title | Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases |
| title_full | Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases |
| title_fullStr | Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases |
| title_full_unstemmed | Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases |
| title_short | Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases |
| title_sort | opioid free segmental thoracic spinal anesthesia with intrathecal sedation for breast and axillary surgery report of four cases |
| topic | spinal anesthesia breast cancer surgery axillary surgery intrathecal midazolam intrathecal ketamine |
| url | https://www.dovepress.com/opioid-free-segmental-thoracic-spinal-anesthesia-with-intrathecal-seda-peer-reviewed-fulltext-article-LRA |
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