Regional Anesthesia with Spontaneous Breathing for Trans-Axillary Surgery in Thoracic Outlet Syndrome: A...

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Pain Management

Background:

• Thoracic outlet syndrome (TOS) necessitates surgical decompression when conservative treatments fail.
• Evaluating anesthesia techniques is crucial for optimizing surgical outcomes in TOS patients.

Purpose of the Study:

• To compare the efficacy and safety of regional anesthesia (RA) versus general anesthesia (GA) for TOS surgery.
• To assess pain scores, opioid consumption, and perioperative outcomes in patients undergoing trans-axillary first rib resection for TOS.

Main Methods:

• Retrospective comparative study of 68 patients undergoing trans-axillary first rib resection for TOS.
• Patients were divided into GA (n=29) and RA (n=39) groups.
• RA involved supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks with deep sedation.

Main Results:

• RA group showed significantly lower postoperative pain (NRS 0 vs. 2, p=0.0443) and reduced intraoperative/postoperative opioid consumption (p<0.001, p=0.0418).
• RA was associated with shorter surgical duration (p=0.0008), decreased postoperative nausea and vomiting (PONV) (p=0.0312), and fewer intraoperative lung injuries (p<0.0001).
• RA group experienced a significantly shorter hospital stay.

Conclusions:

• Regional anesthesia (RA) using SBP and PECS II blocks offers significant advantages over general anesthesia (GA) for TOS surgery.
• RA improves perioperative outcomes, including pain control, opioid reduction, and complication rates.
• Further prospective studies are needed to confirm long-term outcomes of RA in TOS surgery.