Anesthetic technique reduces pain after breast removal – 11/26/2023 – Balance and Health

Treatments for breast cancer have advanced, with increased survival rates, but challenges remain regarding how to deal with chronic pain resulting from breast removal surgery, a condition that can affect between 40% and 70% of patients and which, not rarely, it leads to depressive symptoms.

An anesthetic strategy developed by researchers at Hospital Sírio-Libanês (SP) managed to alleviate these pains, according to a recent study published in the journal Nature.

The technique combines a nerve block in the breast region with general anesthesia routinely used in surgery. Using guided ultrasound, local anesthetic medications are applied to block the conduction of painful stimuli through the nerves at specific points in the breast region.

The results show that pain reduction occurs both in the post-surgical period and up to a year after the procedure — the period during which the women were followed in the study.

Symptoms of depression were also much lower in patients who had the block associated with general anesthesia: 20% versus 50% of those who received anesthesia alone.

The technique, incorporated into breast surgeries at Sírio and other public and private institutions in the country, is being studied in other situations. Patients with femur fractures have received a peripheral nerve block even before surgery to relieve pain.

The work of Sírio researchers began in 2018 and involved 49 women with breast cancer who underwent total mastectomy (breast removal). One group received only general anesthesia (standard procedure), and the other also received local anesthetic in specific regions, such as between the pectoral muscles and below the serratus muscle, located between the lateral walls of the chest.

“The idea was to ensure that we were able to get an innervation that covered the entire breast. Today we discuss the best combinations of blocks, but it is already clear that anesthesia alone is no longer the gold standard. The gold standard is the block together” , explains neuroscientist Raquel Martinez, researcher at the Sírio Institute of Education and Research and the USP Faculty of Medicine.

For her, one of the advantages is the low cost of the technique. “It’s not an expensive thing. You need to have an ultrasound, equipment that already exists. But it’s essential to have qualifications and training.” The study is part of a project supported by Fapesp and also received resources from Proadi (SUS Institutional Development Support Program).

In 2018, women who received anesthetic block showed a reduction in pain indicators 24 hours after surgery. “We noticed that, with less pain, they needed less opioids,” says Martinez.

The patients continued to be monitored and, one year later, a reduction in pain in other parts of the body was also observed among those who received the block associated with general anesthesia. Those who only received general anesthesia needed more painkillers after surgery.

The researcher explains that, when the peripheral nerve is blocked with local anesthetic, the conduction of the nerve impulse is blocked for hours, stopping pain signaling during surgery. “It ends up having a lasting effect.”

For Martinez, advancing solutions to alleviate chronic pain in women after breast cancer treatments has a direct impact on improving mental health. “Pain generates what we call painful behavior, a situation that leads to anxiety and depressive symptoms. With less pain, she will have a better quality of life.”

There are other causes attributed to chronic pain after a mastectomy, such as the accumulation of fluid (lymphedema) in the tissues near the lymph nodes removed during surgery. This results in swelling, pain, and a heavy feeling in the affected arm.

Because this condition causes ongoing discomfort and pain in the arm, it can also lead to a loss of flexibility and range of motion in the shoulder on the side where the breast was removed.

According to mastologist José Luiz Bevilacqua, oncological surgeon at Sírio-Libanês, it is also very common for patients to experience discomfort after mastectomy, especially bilateral mastectomy, caused by loss of sensitivity.

“It’s as if a band of the chest is anesthetized. The patient feels like it is being squeezed. Depending on the degree of anxiety and depression, they suffer a lot from it.”

In these cases, one of the recommendations is that the patient performs self-stimulation in the operated area by looking in a mirror. “We advise you to pass your hand over the new breast, training your brain to reduce this sensation.”

Psychologist Luciana Holtz, president of the Oncoguia Institute, recalls that pain after breast cancer surgery can be multifactorial.

“Breast removal has a huge physical and emotional impact, it absurdly affects women’s issues of femininity and sexuality.”

For her, one of the central points is that the pain of mastectomized women is still not valued. “As important as techniques such as anesthetic block are, it is necessary to take a comprehensive look at this pain so that it does not persist.”

Holtz tells the story of a patient, a nurse, who is trying to retire due to the chronic pain she experiences after a mastectomy. “Her biggest complaint is this pain that persists and is being overestimated by the expert. [do INSS].”