Background and Aims: General anaesthesia (GA) is the standard technique for breast cancer surgery, but the complications associated with it outweigh its benefits. To overcome this, segmental thoracic spinal anaesthesia (STSA) is an imminent technique but is still considered controversial. We hypothesised can STSA could be a safe and effective alternative to GA for breast cancer surgery. Methods: In this single-blinded randomised study, 70 patients undergoing breast cancer surgery were randomly divided into two groups, Group GA and Group STSA. The primary outcome of this study was patient satisfaction score, while secondary outcomes were postoperative pain, time of first rescue analgesia, haemodynamic changes, perioperative complications, discharge time and surgeon satisfaction score. Quantitative variables were expressed as mean ± standard deviation and qualitative variables as frequency. Group comparisons were performed using the Student’s t -test and Chi-square test, with P ≤ 0.05 considered statistically significant. Results: Patients in the Group STSA reported higher satisfaction ( n = 28/32) compared to the Group GA ( n = 12/35). Pain scores were consistently higher in the Group GA; more patients required rescue analgesia (21/35 vs. 7/32 in STSA, P = 0.003). GA patients also showed increased heart rates and a lower incidence of hypotension (1/35 vs. 12/32 in STSA). Only one STSA patient experienced bradycardia. Post-operative nausea and vomiting were more common in the Group GA. Conclusion: Awake breast surgery can be carried out safely and effectively with STSA, where a general anaesthetic poses a high risk. STSA was associated with higher patient satisfaction than GA in patients undergoing breast cancer surgery. STSA provides better pain control, less opioid use and earlier recovery. Nerve twitching during axillary dissection was effectively managed with cold scissors or bipolar diathermy.
Saxena et al. (Thu,) studied this question.