Modified radical mastectomy under local anesthesia using Tumescent Technique experience of Teaching Hospitals in Iraq

Aim: To evaluate the advantages, disadvantages, safety, and restrictions of local anaesthetic against general anesthesia for mastectomy.

Materials and Methods: In this prospective clinical trial, which was carried out at Al-Sader teaching hospital from October 2020 to September 2023, 25 patients (LA group) with a mean age of 64.0±6.3 years (range 55-76 years) underwent a unilateral total mastectomy for breast cancer under local anesthesia using tumescent technique (by manual infiltration technique), and an additional 25 patients (GA group) as a control group with a mean age of 64.9±6.9 years (range 55-75 years) underwent a unilateral mastectomy.

Results: With use of light sedation for 6 patients, anesthetic is sufficient for all 25 patients. The amount of blood loss intraoperatively measured by number of gauze used during the procedure, approximately 3 gauze, 20 cc of blood for each gauze was significantly lower in LA group than GA group, 2.7±0.4, 5.4±0.4 gauze respectively P<0.001. More than 8 hours after surgery, patients are pain-free. No postoperative complications like necrosis of skin flap, wound infection, or hematoma, when compared to GA group, surgery took substantially longer in LA group 48.9±14.3 minutes than in GA group 38.2±2.9 minutes; P<0.001. The day after the surgery, the patient was discharged.

Conclusions: The use of tumescent anesthesia (which is safe and effective) is an attractive alternative method for general anesthesia in properly selected candidates (class IV according to American society of anesthesia).