Bespoke regional blocks for axillary sentinel node biopsy
| Autor: | Sarah Hemington-Gorse, Rachel Clancy, S. Pope-Jones, Jonathan J. Cubitt, C Beynon, C Egeler, A Jayakumar |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Skin Neoplasms Context (language use) Comorbidity Global Health 03 medical and health sciences Patient safety 0302 clinical medicine Anesthesia Conduction 030202 anesthesiology medicine Humans General anaesthesia Prospective cohort study General anaesthetic Melanoma Pandemics Sentinel Lymph Node Biopsy business.industry General surgery COVID-19 Sentinel node Surgery Axilla 030104 developmental biology medicine.anatomical_structure Lymphatic Metastasis Lymph Node Excision Patient-reported outcome Lymph Nodes business |
| Zdroj: | Journal of Plastic, Reconstructive & Aesthetic Surgery. 74:2776-2820 |
| ISSN: | 1748-6815 |
| Popis: | Summary Introduction Axillary sentinel node biopsy for melanoma is routinely performed under general anaesthesia. Emerging evidence has shown general anaesthetics are associated with increased mortality in the context of the COVID-19 pandemic. In the interest of patient safety, we have designed a series of bespoke axillary regional blocks enabling surgeons to remove nodes up to and including level III without the need for a general anaesthetic. The aim of this study was to assess the feasibility of performing axillary sentinel node biopsy under such blocks. Methods Approval was granted by the Joint Study Review Committee on behalf of the Research and Ethics Department. Ten consecutive patients having axillary sentinel node biopsy for melanoma were included in this prospective study. Patients completed a Quality of Recovery-15 (QoR15) questionnaire preoperatively and 24 h postoperatively. Discussion One patient had a positive sentinel node, the remining were negative. A significant reduction in time spent in hospital post-operatively (p = 0.0008) was observed. QoR15 patient reported outcome measures demonstrated high levels of satisfaction evidenced by lack of statistical difference between pre and post-operative scores (p = 0.0118). 80% of patients were happy to have a regional block and 90% were happy to attend hospital during the pandemic. Conclusion ASNB under regional block is safe, negates risks associated with performing GAs during the COVID-19 pandemic and facilitates quicker theatre turnover and discharge from hospital. Collaboration between anaesthetic and surgical teams has enabled this change in practice. There is a learning curve with both patient selection, education and development of technique. |
| Databáze: | OpenAIRE |
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