Breast cancer is the most common type of cancer in women, oftentimes treated with mastectomy, a procedure that removes the entire breast. While the procedure is effective in treating cancer, many patients experience considerable post-operative pain. At Brigham and Women’s Faulkner Hospital, anesthesiologists and surgeons are working together to reduce post-operative pain for their patients having a mastectomy with immediate reconstruction.
The anesthesiology team, led by BWFH’s Chief of Anesthesiology David Shaff, MD, has worked collaboratively with Chief of the Division of Breast Surgery at Brigham Health and Dana-Farber/Brigham and Women’s Cancer Center Tari King, MD, FACS, and Brigham Health’s Chief of Plastic and Reconstructive Surgery Andrea Pusic, MD, MHS, FACS, FRCSC, to develop a new protocol that uses regional anesthesia.
“The procedure takes place before the patient enters the operating room, using a little bit of sedation,” explains Dr. Shaff. “The purpose is to decrease the amount of narcotic we need to use during surgery and in the recovery room. Because we are able to numb the skin and the tissue below with a nerve block, it doesn’t require as much medication to make the patient comfortable after their surgery.”
Dr. Shaff says using the nerve block before surgery greatly improves the patient’s recovery after surgery. “In addition to decreasing the use of narcotics, we have found that this protocol also decreases post-operative nausea and vomiting, and we hope it can also decrease chronic post-mastectomy pain. There is also data to suggest that post-operative pain might modulate the immune system, which may lead to faster recovery.”
Currently, the new protocol is being used only in patients undergoing mastectomy with immediate reconstruction, but the team is optimistic they will soon be able to use regional anesthesia with all mastectomy patients. “Post-operative pain management is very important when it comes to recovery and discharge from the hospital. We’re hoping that by adding regional anesthesia, patients will experience less pain and some mastectomy patients may be able to go home after a brief observation period as opposed to being admitted to the hospital,” says Dr. Shaff.
Another way the team is helping to improve the patient experience is by performing the injections needed to identify the sentinel lymph nodes, the first nodes under the arm that drain the breast, in the operating room after patients have received sedation. “In the past, patients went to nuclear medicine for an injection the day before their surgery or early in the morning on the day of surgery,” says Dr. King. “This required patients to make an additional trip to the hospital and our patients often told us that this injection was painful. We now do these injections in the operating room after the patient is under anesthesia, which takes away the need for a separate appointment and also takes away any discomfort associated with the injections.”
Through cutting-edge treatment options and improved pain management, Brigham Health experts at BWFH work together every day to improve the patient experience and outcomes for women with breast cancer.
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