4 Role of Regional Anaesthesia in Breast Surgery Outcome Breast cancer requires various surgical interventions like lumpectomy or mastectomy along with axillary lymph node clearance. 2 These include ...decreased need for opioids for controlling post-operative pain, decreased post-operative nausea vomiting (PONV), fewer post-operative pulmonary complications and decreased duration of post-anaesthesia care unit stay. Regional anaesthesia may reduce cancer progression by attenuation of the surgical stress response, better analgesia, and reduced opioid usage, and by the direct protective action of local anaesthetics on cancer cells migration. ...different investigators have suggested that any intervention that could modulate all these factors would have a major impact on cancer progression and metastasis. Among the earliest published papers is a retrospective analysis on breast cancer patients which found that patients operated under paravertebral anaesthesia and analgesia combined with general anaesthesia had a lower incidence of breast cancer recurrence than patients who received general anaesthesia alone for mastectomy and axillary clearance. Opioids promote tumour growth and metastasis by modulation of cellular and humoral responses leading to immunosuppression, direct action on tumour cells and immune or endothelial cells and the activation of neuroendocrine-mediated stress response leading to the progression of metastasis and angiogenesis. The systemic effects of local anaesthetics agents used for regional blocks have been documented to be cancer protective by inhibition of TNF-α-induced Srcactivation and intercellular adhesion molecule-1 phosphorylation, inhibition of the epidermal growth factor receptor (EGFR) pathway, antiproliferation of mesenchymal stem cells and blockade of the α-subunit of voltage-gated sodium channels. Sakaguchi M, Kuroda...
Methodology for research I Garg, Rakesh
Indian journal of anaesthesia,
09/2016, Volume:
60, Issue:
9
Journal Article
Peer reviewed
Open access
The conduct of research requires a systematic approach involving diligent planning and its execution as planned. It comprises various essential predefined components such as aims, population, ...conduct/technique, outcome and statistical considerations. These need to be objective, reliable and in a repeatable format. Hence, the understanding of the basic aspects of methodology is essential for any researcher. This is a narrative review and focuses on various aspects of the methodology for conduct of a clinical research. The relevant keywords were used for literature search from various databases and from bibliographies of the articles.
...the presence of fluids at the surgical site is sometimes mistaken for inflammatory lesions. ...needling for regional blocks could have concerns related to infection, tumor seedling by breaching ...the surgical plane and, at times, haematoma formation. 17,18,19 Although the muscles regenerate, continuous infusion of local anaesthetics may affect the regeneration process. Because local anaesthetics are injected in planes without pressure measurement and hydrodissection is not done to identify the correct plane, myotoxicity may occur depending on the drug volume, pressure during drug injection or the direct effects of the chemicals. ...the newer regional blocks including fascial plane blocks appears to be promising for providing optimal analgesia during various surgical procedures.
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