Role of Thoracic Epidural Anesthesia in Providing Adequate Intraoperative and Postoperative Opioid-free Analgesia for Breast Cancer Surgeries.

[BACKGROUND] Breast cancer is the most common malignancy in women. Postoperative pain and opioid analgesics are suspected to influence cancer recurrence. In this study, we try to assess the feasibility of providing complete opioid-free surgical anesthesia and postoperative analgesia for breast cancer surgeries.

[METHODOLOGY] This prospective observational study was performed on 30 patients posted for breast cancer surgery under thoracic epidural anesthesia. The epidural catheter was placed in the upper thoracic space. A titrated bolus of 10-12 mL of 2% lignocaine with adrenaline followed by an infusion of 0.2% ropivacaine at 5-10 mL/hour was used. Time taken from epidural bolus to skin incision, the total dose of local anesthetic and propofol required, postoperative pain score, the patient and surgeon satisfaction score, and adverse events were noted.

[RESULTS] Opioid-free epidural anesthesia was successful in all patients. The average time required to start the surgery after placement of the epidural catheter was 17.8 ± 2.5 min. The average total dose of local anesthetic and propofol supplemented was 6.9 ± 4.5 mL and 18.9 ± 11.8 mg, respectively. Postoperative pain scores were <4 at all time points. The average surgeon and patient satisfaction scores were 9.1 ± 0.2 and 9.1 ± 0.2, respectively. Thirteen percent of patients required treatment for hypotension. There were no episodes of bradycardia or airway compromise.

[CONCLUSIONS] Based on our data, it appears to be safe to perform opioid-free breast cancer surgeries under thoracic epidural anesthesia with complimentary sedation and local infiltration. Epidural infusion of local anesthetic provides excellent intra- and postoperative analgesia, which helps avoid the use of opioids.