Impact of Pectoralis Nerve Block (PECS) on postoperative pain in patients submitted to mastectomy with lymphadenectomy.

OBJECTIVE: Breast cancer is the most common malignant neoplasm in women worldwide. Surgery has been traditional treatment and, generally, it´s mastectomy with lymphadenectomy, that can causes postoperative pain. Therefore, we seek to study regional anesthesic techniques that can minimize this effect, such as the interpectoral block (PECS). METHODS: randomized controlled study with 82 patients with breast cancer who underwent mastectomy with lymphadenectomy from January 2020 to October 2021 in oncology hospital. INTERVENTIONS: two randomized groups (control - exclusive general anesthesia and PECS group - received PECS block with levobupivacaine/ropivacaine and general anesthesia). We applied a questionnaire with Numeric Rating Scale for pain 24h after surgery. We used Shapiro-Wilk, Mann-Whitney and Chi-square tests, and analyzed the data in R version 4.0.0 (ReBEC). RESULTS: in the PECS group, 50% were pain-free 24h after surgery and in the control group it was 42.86%. The majority who presented pain classified it as mild pain (VAS from 1 to 3) - (42.50%) PECS group and (40.48%) control group (p=0.28). Only 17.50% consumed opioids in the PECS group, similar to the control group with 21.43%. (p=0.65). There was a low rate of complications such as PONV in both groups. In the subgroup analysis, there was no statistical difference between the groups that used levobupivacaine or ropivacaine regarding postoperative pain and opioid consumption. DISCUSSION: the studied group had a low rate of pain in the postoperative period and it influenced the statistical analysis. There wasn´t difference in postoperative pain in groups. CONCLUSION: was not possible to demonstrate better results with the association of the PECS block with total intravenous analgesia. Need further studies to assess the efficacy of the nerve block.

The Influence of an Online Platform (Hernia U) in Surgical Education and Patient Management.

Introduction: Hernia U was created with the objective to expand the educational landscape of abdominal wall surgery. It is an online platform where surgeons can register with no cost and subscribe for different courses. The aim of this study is to evaluate the impact of the platform on patient management and surgical education. Methods: A questionnaire regarding the influence of Hernia U in surgical education and patient management was emailed to professionals who had previously participated in any course of the Hernia U. Variables were shown with absolute and relative frequencies. Pearson's χ2 and Fisher's exact test were performed to analyze relationships between variables as appropriate. Results: Nine hundred three participants responded to the questionnaire. Seven hundred fifty-two (83.3%) were men; 248 (27.4%) participants were older than 50 years old; 240 (26.6%) were between 41 and 50 years old. Two hundred seventy-four (30.4%) participants had been in practice for more than 20 years, 242 (26.8%) between 11 and 20 years, and 161(17.8%) between 5 and 10 years. When analyzing the impact of time spent on the platform, spending over an hour per week was significantly associated with self-reported change in practice patterns compared to spending less than an hour per week (p < 0.0003). More experienced surgeons (10 or more years of practice) were less likely to change their practice patterns when compared to less experienced surgeons. Conclusion: Hernia U has allowed surgeons to change their daily practice and to boost their education. Surgeons spending more than one hour weekly in the platform are more likely to adopt changes.

Is Minimally Invasive Repair the New Gold Standard for Primary Unilateral Inguinal Hernias? Results of an International Survey of Surgeons.

Background: The Lichtenstein repair has long been heralded as the gold standard for unilateral primary inguinal hernias. However, minimally invasive surgery (MIS) repairs have gained popularity over the past decades given its advantages in recurrent, bilateral, and now even in primary inguinal hernias. We aim to further explore the perception of different techniques among surgeons internationally. Methods: A questionnaire was posted in three closed groups for surgeons and residents on Facebook® and surgical groups on WhatsApp®. It was also e-mailed to members of the following surgical societies: Mexican Society of Surgery, Brazilian Hernia Society, Asia Pacific Hernia Society, and European Hernia Society. Descriptive and basic comparative statistical analyses were performed. Results: In total, 874 surgeons answered the survey: 759 (86.9%) were male and 418 (47.8%) were from North America, 735 (84.1%) had completed training and 605 (69.2%) considered themselves hernia specialists. If safety profiles of inguinal herniorrhaphy were equal, 533 (61%) would choose MIS. Laparoscopic transabdominal preperitoneal ranked first among preferred techniques if the cost of all techniques was the same. Safety of the procedure followed by experience of the surgeon is the most influential factors. Lastly, hernia specialists were more likely to choose an MIS technique (P < .0001). Conclusion: When an international sample of 874 attending and trainee surgeons were surveyed about what technique they would prefer to repair their own uncomplicated unilateral inguinal hernia, most chose MIS. Safety of the procedure and the surgeon's experience were the most important factors in choosing a surgical technique.

Impact of Pectoralis Nerve Block (PECS) on postoperative pain in patients submitted to mastectomy with lymphadenectomy / Impacto do Bloqueio Peitoral (PEC) na dor pós-operatória em pacientes submetidos a mastectomia com linfadenectomia

ABSTRACT Objective: Breast cancer is the most common malignant neoplasm in women worldwide. Surgery has been traditional treatment and, generally, it´s mastectomy with lymphadenectomy, that can causes postoperative pain. Therefore, we seek to study regional anesthesic techniques that can minimize this effect, such as the interpectoral block (PECS). Methods: randomized controlled study with 82 patients with breast cancer who underwent mastectomy with lymphadenectomy from January 2020 to October 2021 in oncology hospital. Interventions: two randomized groups (control - exclusive general anesthesia and PECS group - received PECS block with levobupivacaine/ropivacaine and general anesthesia). We applied a questionnaire with Numeric Rating Scale for pain 24h after surgery. We used Shapiro-Wilk, Mann-Whitney and Chi-square tests, and analyzed the data in R version 4.0.0 (ReBEC). Results: in the PECS group, 50% were pain-free 24h after surgery and in the control group it was 42.86%. The majority who presented pain classified it as mild pain (VAS from 1 to 3) - (42.50%) PECS group and (40.48%) control group (p=0.28). Only 17.50% consumed opioids in the PECS group, similar to the control group with 21.43%. (p=0.65). There was a low rate of complications such as PONV in both groups. In the subgroup analysis, there was no statistical difference between the groups that used levobupivacaine or ropivacaine regarding postoperative pain and opioid consumption. Discussion: the studied group had a low rate of pain in the postoperative period and it influenced the statistical analysis. There wasn´t difference in postoperative pain in groups. Conclusion: was not possible to demonstrate better results with the association of the PECS block with total intravenous analgesia. Need further studies to assess the efficacy of the nerve block.

RESUMO Introdução: o câncer de mama é a neoplasia maligna mais comum em mulheres no mundo. A cirurgia tem sido o tratamento tradicional e, geralmente consiste em mastectomia com linfadenectomia, podendo causar dor pós-operatória. Por isso, buscamos estudar técnicas anestésicas regionais que possam minimizar esse efeito, como o bloqueio interpeitoral (PEC). Métodos: estudo controlado randomizado com 82 pacientes com câncer de mama submetidos à mastectomia com linfadenectomia de Janeiro de 2020 a Outubro de 2021, em hospital oncológico. Intervenções: dois grupos randomizados (controle - anestesia geral exclusiva e grupo PECS - anestesia geral e bloqueio PEC com levobupivacaína/ropivacaína). Aplicou-se um questionário com Escala Visual Analógica da dor 24h pós-cirurgia. Utilizamos os testes de Shapiro-Wilk, Mann-Whitney e Quiquadrado e analisamos os dados em R versão 4.0.0. Estudo registrado em Ensaios Clínicos Brasileiros (REBec). Resultados: no grupo PEC, 50% não apresentava dor 24 horas após a cirurgia enquanto no grupo controle, 42,86% negava quadro álgico. A maioria que apresentou dor classificou-a como dor leve (EVA de 1 a 3) - (42,50%) grupo PEC e (40,48%) controle (p=0,28). Apenas 17,50% consumiram opioides no grupo PEC, semelhante ao grupo controle com 21,43%. (p=0,65), (17,50%) grupo PEC e (21,43%) grupo controle (p=0,65). Houve baixo índice de complicações como PONV (náuseas, vômitos, cefaleia) em ambos os grupos. Na análise de subgrupo, não houve diferença estatística entre os grupos que usaram Levobupivacaína ou Ropivacaína quanto a dor pós-operatória e o consumo de opioides. Discussão: o grupo estudado apresentou baixa taxa de dor no pós-operatório e isso influenciou na análise estatística. Não houve diferença estatística quanto a dor pós-operatória entre grupos. Conclusão: não foi possível demonstrar melhores resultados com a associação do bloqueio PEC com analgesia intravenosa total. São necessários novos estudos para avaliar a eficácia do bloqueio anestésico no intraoperatório e pós-operatório.

Factors Associated with 30-Day Mortality in Patients after Percutaneous Endoscopic Gastrostomy.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding. The aim of this study is to investigate the risk factors associated with early mortality after PEG. METHODS: It is a retrospective survival analysis in a tertiary-level hospital. We reviewed the medical records of 277 patients with PEG placement. The data were analyzed by the Kaplan-Meier method. Multivariable Cox proportional regression models were also built to test the effects of PEG on mortality. RESULTS: A total of 277 patients who submitted to PEG were studied. One-hundred and sixty (58%) were female, mean age of 73.3 ± 15.7 years. Ninety-three patients (33.6%) had diabetes mellitus and 165 (59.6%) had blood hypertension. The indications for PEG placement were chronic neurologic dysphagia in 247 (89.5%) patients and tumors and other diseases in 29 (10.5%). The 30 days proportional mortality probability rate was 13%. In a multivariate Cox proportional regression model, preoperative ICU hospitalization (HR 1.79, 95% CI 1.36-2.36, P = 0.000) and hemoglobin (HR 0.91, 95% CI 0.85-0.98, P = 0.015) were predictors of early mortality. CONCLUSION: In patients who had underwent PEG tube insertion for long-term nutrition, anemia and previous ICU admission were predictors of mortality at four weeks. These factors may guide physicians to discourage the indication for PEG.

Doze semanas de exercício físico domiciliar melhora amplitude de movimento do ombro de idosas mastectomizadas em tratamento para câncer de mama / Twelve weeks of home physical exercise improves shoulder range of motion in elderly mastectomized women undergoing treatment for breast cancer

Introdução: A realização de exercícios físicos domiciliares é uma metodologia segura e eficiente. Entretanto, poucos estudos abordam idosas com câncer de mama mastectomizadas. Objetivo: Verificar o impacto de 12 semanas de um programa de exercícios físicos domiciliares na amplitude de movimento do ombro de idosas sobre- viventes de câncer de mama em tratamento. Métodos: Ensaio clínico randomizado, com idosas mastectomizadas (n=33), 18 idosas para Grupo Controle e 15 para o Grupo Intervenção, realizado de abril a novembro de 2015. Foi ofertado ao Grupo Intervenção um manual de exercícios físicos e DVD previamente desenvolvido. Para o estudo, foram analisados os dados referentes ao teste "Alcançar as Costas" da bateria Senior Fitness Test. As idosas foram avaliadas no início da pesquisa e ao término da 12a semana. Foi realizada análise estatística descritiva através do programa estatístico STATA versão 12, com nível de significância de <0,05. Resultados: Após 12 semanas, foram observadas melhora significativa da flexibilidade no grupo de exercícios físicos domiciliares, de acordo com o teste "Alcançar as Costas" da Senior Fitness Test, medido em centímetros (-7.93 ± 11.54 a 0.533 ± 7.9, p <0,02), e tendência de piora do Grupo Controle (-12.5 ± 9.16 a -18.33 ± 9.12, p <0,06). Além disso, alterações referentes à classificação da flexibilidade das idosas de acordo com a idade foram observadas com ganhos para o Grupo Intervenção (p<0.01). Conclusão: A realização de um programa de exercícios físicos domiciliares parece ser sensível para a melhora da amplitude de movimento de idosas mastectomizadas em tratamento de hormonioterapia.(AU)

Introduction: Home-based exercise is a safe and efficient methodology. However, few studies address older women with mastectomized breast cancer. Purpose: To verify the 12-week impact of a home-based exercise program on shoulder range of motion of older women with breast cancer undergoing treatment. Methods: Randomized clinical trial with mastectomized older women (n = 33), 18 for the Control Group and 15 for the Intervention Group, conducted from April to November 2015. A previously developed exercise manual and DVD were offered to the Intervention Group. For the study, data r the "Reaching the Back" test of the Senior Fitness Test battery were analyzed. The older women were evaluated at the beginning of the research and at the end of week 12. Descriptive statistical analysis was performed using the statistical program STATA version 12, with a significance level of <0.05. Results: After 12 weeks, a significant improvement in flexibility was observed in the home-based exercise group according to the Senior Fitness Test Back Scratch test, measured in centimeters (-7.93 ± 11.54 to 0.533 ± 7.9, p <0.02 ), and worsening trend of the Control Group (-12.5 ± 9.16 to -18.33 ± 9.12, p <0.06). In addition, changes regarding the flexibility classification of older women according to age were observed with gains for the Intervention Group (p <0.01). Conclusion: The implementation of a home-based exercise program seems to be sensitive to the improvement of the range of motion of mastectomized older women undergoing hormone therapy.(AU)