Our Summary

This research paper investigates the usage of peripheral nerve blocks (PNB), a type of regional anesthesia, in surgeries for breast cancer such as mastectomy and lumpectomy from 2010 to 2018. The study shows that the use of PNB in these procedures has been increasing, although the overall prevalence is still low. Before 2014, the usage of PNB in these surgeries did not change significantly from year to year. However, after 2014, the odds of PNB usage increased more than two-fold each year for both types of surgeries. Factors that were associated with higher odds of PNB usage included the year of procedure being 2014 or later, the patient being female, the region of the facility, and the use of a tissue expander.

FAQs

  1. What is a peripheral nerve block (PNB) and how is it used in breast cancer surgeries?
  2. Based on the research study, how has the usage of PNB in mastectomy and lumpectomy surgeries changed over the years from 2010 to 2018?
  3. What factors were found to be associated with higher odds of PNB usage in breast cancer surgeries?

Doctor’s Tip

A doctor might tell a patient undergoing a lumpectomy to expect some discomfort and swelling after the surgery, but to follow post-operative care instructions carefully to help manage these symptoms. They may also recommend gentle exercises to promote healing and reduce the risk of complications. Additionally, the doctor may advise the patient to attend follow-up appointments to monitor their recovery and ensure that the surgical site is healing properly.

Suitable For

Lumpectomy is a common surgical procedure recommended for patients with early-stage breast cancer or for those with non-cancerous breast conditions such as atypical hyperplasia or lobular carcinoma in situ. Patients who are recommended lumpectomy typically have smaller tumors that can be removed while preserving as much of the breast as possible. Lumpectomy is also recommended for patients who prefer breast-conserving surgery over mastectomy.

Patients who are recommended lumpectomy may have certain characteristics that make them suitable candidates for this procedure. These characteristics may include:

  • Early-stage breast cancer: Lumpectomy is often recommended for patients with stage 0, I, or II breast cancer, where the tumor is relatively small and has not spread to the lymph nodes or other parts of the body.
  • Small tumor size: Lumpectomy is typically recommended for patients with smaller tumors that can be easily removed while preserving the shape and size of the breast.
  • Negative margins: Lumpectomy is typically recommended for patients whose tumors can be completely removed with clear margins, meaning there are no cancer cells left behind.
  • Good overall health: Patients recommended for lumpectomy should be in good overall health and able to tolerate surgery and anesthesia.
  • Willingness to undergo radiation therapy: Lumpectomy is usually followed by radiation therapy to reduce the risk of cancer recurrence, so patients should be willing to undergo this additional treatment.

Overall, lumpectomy is a suitable option for many patients with early-stage breast cancer or non-cancerous breast conditions, as it offers the opportunity to remove the tumor while preserving the breast as much as possible. Patients recommended for lumpectomy should discuss their options with their healthcare provider to determine the best treatment plan for their individual situation.

Timeline

Before lumpectomy:

  • Patient receives a diagnosis of breast cancer and discusses treatment options with their healthcare provider
  • Decision is made to undergo lumpectomy
  • Patient undergoes pre-operative tests and consultations to prepare for surgery
  • Patient may undergo radiation therapy or chemotherapy before surgery
  • Patient receives instructions on how to prepare for surgery, including fasting and medication guidelines

During lumpectomy:

  • Patient is admitted to the hospital or outpatient surgery center
  • Anesthesia is administered to keep the patient comfortable during the procedure
  • Surgeon removes the tumor and a margin of surrounding healthy tissue
  • Procedure typically lasts a few hours
  • Patient is monitored in the recovery room before being discharged

After lumpectomy:

  • Patient may experience pain, swelling, and bruising at the surgical site
  • Patient is prescribed pain medication to manage discomfort
  • Patient may need to wear a special bra or bandage to support the surgical site
  • Patient is advised to limit physical activity and avoid lifting heavy objects
  • Follow-up appointments are scheduled to monitor healing progress and discuss further treatment options, such as radiation therapy or hormone therapy
  • Patient may undergo breast reconstruction surgery if desired

Overall, the timeline for a patient undergoing lumpectomy involves a series of pre-operative preparations, the surgical procedure itself, and post-operative care and follow-up appointments to ensure a successful recovery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with lumpectomy surgery?
  2. How long is the recovery period after a lumpectomy?
  3. Will I need additional treatments such as radiation therapy or chemotherapy after the lumpectomy?
  4. What are the chances of the cancer returning after a lumpectomy?
  5. Are there any alternative treatment options to consider instead of a lumpectomy?
  6. Will there be any changes to the appearance of my breast after the surgery?
  7. How many lumpectomies have you performed, and what is your success rate?
  8. What type of anesthesia will be used during the lumpectomy?
  9. How long will the lumpectomy procedure take?
  10. When can I expect to receive the results of the pathology report after the lumpectomy?

Reference

Authors: Lam S, Qu H, Hannum M, Tan KS, Afonso A, Tokita HK, McCormick PJ. Journal: Anesth Analg. 2021 Jul 1;133(1):32-40. doi: 10.1213/ANE.0000000000005368. PMID: 33481402