Immune response in breast cancer surgery. A comparative and prospective study of different anesthetic techniques.

INTRODUCTION: The main reason for high mortality in breast cancer is local recurrence and metastasis, despite surgery as the first therapeutic option. The anesthesia used in the operation room can determine the immune response. METHODS: A prospective, comparative and non- randomised study in patients undergoing breast cancer surgery was conducted in our hospital after obtaining approval from the Hospital's Institutional Review Board. Patients were divided in two groups: Group A received general anesthesia with propofol and opioids. Group B, in addition to general anesthesia, three interfascial blocks (Pec I, Pec II and BRILMA) were performed in all patients. Three blood samples were taken 1) previous anesthetic induction; 2) two hours after the end of the surgery and 3) 24-48 h after surgery. Leukocytes, CD3, CD4, CD8 and Natural Killer cells were determined at each time. RESULTS: 103 patients were included. 59 (group A) received general anesthesia and 54 (group B) general anesthesia and interfascial blocks. Regarding baseline characteristics, age was significantly higher in the group that received general anesthesia and mastectomy was more frequent in the group that received interfascial blocks. We observed after surgery an increase in leukocytes level that returns close to baseline levels. On the other hand, a reduction in the immune response was observed that also returns to the previous level 48 h after surgery. Group A and B get similar results and also subgroups of hormonal receptors (HER+, PR and/or ER+). CONCLUSIONS: Interfascial blocks in chest wall added to general anesthesia in breast cancer surgery has not shown a significant difference in the inflammatory response or immunological depression compared to general anesthesia as the only anesthetic technique. It seems to trend less immunological depression in the interfascial block group.

Respuesta inmunológica en cirugía del cáncer de mama. Estudio comparativo y prospectivo de diferentes técnicas anestésicas / Immune response in breast cancer surgery. A comparative and prospective study of different anesthetic techniques

Introducción: El principal motivo de la alta mortalidad en el cáncer de mama es la recurrencia local y las metástasis, siendo la cirugía la primera opción terapéutica. La técnica anestésica utilizada en quirófano puede modificar la respuesta inmunológica del paciente. Métodos: Estudio prospectivo, comparativo y no aleatorizado en pacientes intervenidos de cáncer de mama en el Hospital Universitario de Getafe (Madrid) tras la aprobación del Comité Ético del Hospital.Dividimos a los pacientes en dos grupos: grupo A, que recibió anestesia general con propofol y fármacos opiáceos; grupo B, en el que además de la anestesia general, se realizaron tres bloqueos interfasciales (Pec I, Pec II y BRILMA) en todos los pacientes. Se obtuvieron tres muestras sanguíneas: 1) antes de la inducción anestésica; 2) 2h después de finalizar la cirugía y 3) 24-48h posquirúrgicas. En cada muestra, se analizaron el número de leucocitos, células CD3, CD4 y CD8, así como las células natural killer (NK). Resultados: Se incluyeron en el estudio un total de 103 pacientes; 59 (grupo A) recibieron anestesia general y 54 (grupo B) anestesia general y bloqueos interfasciales. Según las características basales, la edad fue significativamente superior en las pacientes que recibieron anestesia general. La mastectomía se realizó con más frecuencia en el grupo que recibió bloqueos interfasciales. Observamos que después de la cirugía hay un aumento en el número de leucocitos pero regresa a los niveles basales a las 48h, comportamiento que se repite a nivel inmunológico: disminuye después de la cirugía pero vuelve a niveles previos a las 48h de la cirugía. Los grupos A y B presentan resultados similares en el resto de parámetros estudiados, al igual que los subgrupos según los receptores hormonales (HER+, PR y/o ER+).(AU)

Introduction: The main reason for high mortality in breast cancer is local recurrence and metastasis, despite surgery as the first therapeutic option. The anesthesia used in the operation room can determine the immune response. Methods: A prospective, comparative and non-randomized study in patients undergoing breast cancer surgery was conducted in our hospital after obtaining approval from the Hospital's Institutional Review Board. Patients were divided in two groups: Group A received general anesthesia with propofol and opioids. Group B, in addition to general anesthesia, three interfascial blocks (Pec I, Pec II and BRILMA) were performed in all patients. Three blood samples were taken 1) previous anesthetic induction; 2) two hours after the end of the surgery and 3) 24-48hours after surgery. Leukocytes, CD3, CD4, CD8 and Natural Killer cells were determined at each time. Results: 103 patients were included. 59 (group A) received general anesthesia and 54 (group B) general anesthesia and interfascial blocks. Regarding baseline characteristics, age was significantly higher in the group that received general anesthesia and mastectomy was more frequent in the group that received interfascial blocks.We observed after surgery an increase in leukocytes level that returns close to baseline levels. On the other hand, a reduction in the immune response was observed that also returns to the previous level 48hours after surgery. Group A and B get similar results and also subgroups of hormonal receptors (HER+, PR and/or ER+). Conclusions: Interfascial blocks in chest wall added to general anesthesia in breast cancer surgery has not shown a significant difference in the inflammatory response or immunological depression compared to general anesthesia as the only anesthetic technique. It seems to trend less immunological depression in the interfascial block group.(AU)

Bloqueo del cuadrado lumbar: nueva vía de abordaje para el dolor crónico de cadera. Serie de casos / Quadratus lumborum block. New approach for a chronic hip pain. Cases report

La artrosis de cadera es una enfermedad frecuente y de difícil manejo. El dolor que genera supone un gran impacto en la calidad de vida del paciente. El objetivo del tratamiento debe ser reducir el dolor y mejorar la función. Atendiendo a la compleja inervación de la cadera las técnicas mínimamente invasivas han ido en aumento. En este contexto presentamos los resultados obtenidos en 4 pacientes con dolor crónico por coxartrosis a los que realizamos un bloqueo del cuadrado lumbar tipo 2 (QL2) con levobupivacaína más dexametasona como opción terapéutica. Los resultados han mostrado un descenso significativo de la intensidad del dolor evaluado en la escala verbal numérica (EVN) durante un periodo superior a 6 meses

Hip arthrosis is a frequent and difficult to manage disease. The generated pain supposes a great impact in the quality life of the patient. The goal of the treatment should be to reduce pain and to improve function. Based on the complex innervation of the hip, the minimally invasive thecniques have been increasing. In this context, we present the results obtained in four patients with a hip chronic pain due to arthrosis, to whom we performed a quadratus lumborum block type 2 (QL2) with levobupivacaine plus dexametasone as therapeutic option. The results have shown a significant decrease of the intensity of pain (NRS) for more than 6 months

Quadratus lumborum block. New approach for a chronic hip pain. Cases report. / Bloqueo del cuadrado lumbar: nueva vía de abordaje para el dolor crónico de cadera. Serie de casos.

Hip arthrosis is a frequent and difficult to manage disease. The generated pain supposes a great impact in the quality life of the patient. The goal of the treatment should be to reduce pain and to improve function. Based on the complex innervation of the hip, the minimally invasive thecniques have been increasing. In this context, we present the results obtained in four patients with a hip chronic pain due to arthrosis, to whom we performed a quadratus lumborum block type 2 (QL2) with levobupivacaine plus dexametasone as therapeutic option. The results have shown a significant decrease of the intensity of pain (NRS) for more than 6 months.

[Anesthetic treatment of patients with osteogenesis imperfecta]. / Experiencia en el tratamiento anestésico de los pacientes afectos de osteogénesis imperfecta.

BACKGROUND AND OBJECTIVE: Although the prevalence of osteogenesis imperfecta is low, the effect of this hereditary disease on patients' quality of life is considerable. We report our experience in the perioperative management of patients with this condition in our hospital. PATIENTS AND METHODS: Retrospective study describing the interventions on patients with this disease in our hospital from 1991 to 2009. We analyzed demographic data, disease variants, concomitant disorders, surgical procedures, type of anesthesia, and intraoperative and postoperative complications. RESULTS: From 1991 to 2009, 105 procedures were performed on 29 patients (ages 1 to 25 years) with osteogenesis imperfecta (37.9% women and 62.1% men). The most common type of osteogenesis imperfecta was type III (65.5%). Most patients (93%) had no associated diseases. Two patients were allergic to latex. No complications occurred in 62% of interventions. Reported complications during surgery were 1 case of non-malignant hyperthermia and 1 contralateral femur fracture. CONCLUSIONS: The prevalence of osteogenesis imperfecta is low. Treatment requires a multidisciplinary approach, in which appropriate perioperative management must be based on a proper understanding of the skeletal and extraskeletal abnormalities associated with this disease.

Experiencia en el tratamiento anestésico de los pacientes afectos de osteogénesis imperfecta / Anesthetic treatment of patients with osteogenesis imperfecta

Objetivos: La osteogénesis imperfecta es una enfermedad hereditaria con una baja prevalencia, pero gran impacto en la calidad de vida de los pacientes. Se presenta la experiencia en el manejo perioperatorio de estos pacientes en nuestro hospital. Pacientes y métodos: Estudio descriptivo retrospectivo de las intervenciones realizadas en nuestro centro durante los años 1991 a 2009, en los pacientes con esta enfermedad. Se analizan los datos demográficos, variante de la enfermedad, alteraciones asociadas, procedimientos quirúrgicos, tipo de anestesia y complicaciones intraoperatorias y postoperatorias. Resultados: Desde el año 1991 hasta el 2009 se han realizado un total de 105 intervenciones en 29 pacientes con osteogénesis imperfecta (37,9% mujeres, 62,1% varones), con una edad que oscila entre 1 a 25 años. El tipo más frecuente de osteogénesis imperfecta fue el tipo III (65,5%). El 93% de los pacientes no presentaron enfermedades asociadas. Dos pacientes eran alérgicos al látex. El 62% de las intervenciones transcurrieron sin complicaciones. Se registró un caso de hipertermia no maligna y una fractura de fémur contralateral en el quirófano. Conclusiones: La osteogénesis imperfecta es una enfermedad de baja prevalencia que precisa un tratamiento multidisciplinar. Es necesario un adecuado conocimiento de las alteraciones tanto esqueléticas como extraesqueléticas de esta enfermedad para un correcto tratamiento perioperatorio(AU)

Background and objective: Although the prevalence of osteogenesis imperfecta is low, the effect of this hereditary disease on patients’ quality of life is considerable. We report our experience in the perioperative management of patients with this condition in our hospital. Patients and methods: Retrospective study describing the interventions on patients with this disease in our hospital from 1991 to 2009. We analyzed demographic data, disease variants, concomitant disorders, surgical procedures, type of anesthesia, and intraoperative and postoperative complications. Results: From 1991 to 2009, 105 procedures were performed on 29 patients (ages 1 to 25 years) with osteogenesis imperfecta (37.9% women and 62.1% men). The most common type of osteogenesis imperfecta was type III (65.5%). Most patients (93%) had no associated diseases. Two patients were allergic to latex. No complications occurred in 62% of interventions. Reported complications during surgery were 1 case of non-malignant hyperthermia and 1 contralateral femur fracture. Conclusions: The prevalence of osteogenesis imperfecta is low. Treatment requires a multidisciplinary approach, in which appropriate perioperative management must be based on a proper understanding of the skeletal and extraskeletal abnormalities associated with this disease(AU)