Vol. 5, Issue 12 (2019)
The Ultrasound-guided Erector Spinae plane block allows opioid-free Anesthesia in the modified radical mastectomy with axillary lymph node dissection: A pilot study about 14 cases from the national Institut of oncology of Morocco
Author(s): Safia El Ayoubi, Brahim El Ahmadi, Zakaria H Belkhadir, Abdelilah Ghannam
Abstract: The Modified radical mastectomy with axillary dissection (MRMAD) is common in the surgical management of breast cancer witch Usually carried out under balanced general anesthesia using opiates. Opioid-free anesthesia (OFA) aims to reduce the undesirable effects of opioids while ensuring optimal anesthesia and analgesia perioperatively. We report the experience of the National Institute of Oncology’s Anesthesia team in the implementation of an OFA protocol in breast cancer surgery based on the Erector Spiane plane block (ESPB). We recruited patients scheduled for MRMAD, class ASA I and II, without any contraindications to the anesthetic technique and who are consenting. The protocol included standard monitoring, bispectral index monitoring, propofol-based intravenous induction without curarization, an ultrasound-guided erector spinae plane block and controlled assisted ventilation by a supra-glottic device. Prior to incision, patients received a bolus Ketamine, Ketoprofen, and dexamethasone. Maintenance was performed by sevoflurane. We included 14 patients. The median age was 51 years, the median BMI was 25.9 kg / m². 13 patients were ASA 1. All patients were anesthetized and analgesia without modification of the protocol described. At day 1, out of the 98 VAS surveys performed, in 94 cases the response was less than 3/10. No cases of PONV were noted. Only one patient received a bolus of 3 mg morphine IV as part of the catch-up analgesia. All patients had no resting pain. 5 patients had low mobilization pain without hyperalgesia. The DN4 score was <4/10 in all patients. Overall satisfaction with analgesia had a median of 8.5 / 10. The ESPB allows to practice anesthesia and analgesia in a safe way and with high quality, avoiding the para vertebral block complications and theanterior Serratus Block variable efficiency.