Analgesia pós-operatória em cirurgias oncológicas de mama: técnicas anestésicas e papel das citocinas.

Abstract

Introduction and Objectives: Analgesia in surgeries for the treatment of breast cancer is still a challenge, since many patients do not have their pain properly controlled, which delays recovery, hospital discharge time and can still cause chronic pain syndrome. There are several techniques for postoperative pain control, including US-guided anesthetic Erector Spinae Plane Block (ESPB).This study aimed to evaluate postoperative pain by comparing two anesthetic techniques and the use of analgesics in the postoperative period; to compare the preoperative serum cytokine level with the postoperative levels; and to determine the influence of the anesthetic technique on the measurement of plasma cytokines. Methods: A double-blind, controlled and randomized study was performed with 36 women who underwent oncological breast surgeries. Patients were allocated into two groups: one group received general anesthesia only (group G; n=20) and the other group received Erector Spinae Plane Block (ESPB) (group E; n=16).The pain (Visual Analog Scale) at 2, 24 and 48 hours after surgery, and the serum TNF-α, IL-8 and IL-1 levels pre-surgery and at 24 and 48 hours after surgery were evaluated. Results: Moderate or severe pain were more frequent in group G, both for mastectomy and quadrantectomy, 24 hours after surgery (p=0,016). Serum TNF-α levels were very similar pre-surgery and 24 hours after surgery, 9 with a significant reduction after 48 hours (p= 0.010). IL-8 levels were lower in group E than in group G (p= 0,029), and there was a reduction in IL-8 after 24 hours of surgery (p<0,001). There is an increase in IL-1 levels after 48 hours of surgery (p<0,001). Discussion: The study implies the possibility of changes in the analgesia protocol for surgeries on the breast cancer, since proving the effectiveness of ESPB. This technique is an alternative anesthesia that is easy to access and perform, and would reduce hospitalization and hospital costs.