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ORIGINAL ARTICLE   

Minerva Anestesiologica 2022 September;88(9):668-79

DOI: 10.23736/S0375-9393.22.16532-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

A French nationwide survey on the practice of regional anesthesia for breast cancer surgery

Guillaume GAYRAUD 1, Dalia DE CASTRO 1, Kevin PERRIER 2, Ioana MOLNAR 3, Christian DUALÉ 4, 5

1 Anesthesia and Intensive Care Unit, Centre Jean-Perrin, Clermont-Ferrand, France; 2 Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; 3 Department of Clinical Research and Innovation, Jean-Perrin Center, Clermont-Ferrand, France; 4 Clinical Investigation Center (INSERM CIC1405), CHU Clermont-Ferrand, Clermont-Ferrand, France; 5 INSERM Neuro-Dol U1107, Clermont-Ferrand, France



BACKGROUND: The aim of this study was to assess the impact of recent recommendations concerning regional anesthesia for breast cancer surgery, a nationwide practice survey was carried out.
METHODS: This cross-sectional electronic survey, conducted in 2021, collected answers from a panel of anesthetists currently working in French practicing centers. It addressed the sets of techniques they practiced for every type of surgical procedure and their perceptions of the difficulties and risks associated with these techniques.
RESULTS: The practice of regional anesthesia was generally high (70%), involving all the current types of blocks. Surgeon-done infiltration was popular for lumpectomy only. For the other current procedures, the pectoralis nerve blocks were preferred to the paravertebral block, which was favored for mastectomies, when a lymph node harvesting was planned, or for immediate or delayed pedicle flap. Catheters were mostly used for mastectomies with pedicle flap. The erector spinae plane block was emergent. Whatever the type of block, regional anesthesia was preferentially started before surgery. Despite some deviations such as the adjunction of unlabeled molecules, the practice fitted well with the European recommendations, but training and within-center guidance lacked standardization. For each block, actual practice, perceived difficulty, and risk were inter-correlated, but paravertebral block - either practiced or not - was considered as more difficult and riskier to perform than any other.
CONCLUSIONS: These encouraging results do not dispense with the need to improve anesthetic practices both in quantity and quality. Such improvement in the anatomic fit to the procedure and in the timing of blocks will also have to be considered.


KEY WORDS: Breast neoplasms; Mastectomy; Pain, postoperative; Hyperalgesia; Anesthesia, local

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