Thoracic epidural anesthesia improves outcome after breast surgery

The authors' objective was to compare the outcomes, including the incidence of nausea and vomiting and the time until discharge to home, of patients undergoing general anesthesia and thoracic epidural anesthesia for oncologic breast procedures.

General anesthesia is the traditional anesthetic technique used in oncologic breast procedures. In March 1993, the authors initiated the use of high thoracic epidural anesthesia for patients undergoing oncologic breast surgery and reconstructive procedures.

A retrospective analysis was undertaken of 136 operations performed by one surgeon (T.J.E.) at Brigham and Women's Hospital. A chi square analysis was used to compare the outcomes of patients undergoing general anesthesia and thoracic epidural anesthesia.

Compared with general anesthesia, thoracic epidural anesthesia was associated with a statistically significant earlier hospital discharge (p = 0.01). For quadrantectomy/axillary node dissection procedures, 20 of 39 patients (51%) having thoracic epidural anesthesia were discharged on the operative day versus 7 of 32 patients (22%) in the general anesthesia group. Furthermore, 8 of 39 patients (20%) in the thoracic epidural group experienced nausea and/or vomiting during their hospital stay versus 18 of 32 patients (56%) in the general anesthesia group (p = 0.002).

Thoracic epidural anesthesia is a safe technique not associated with neurologic or respiratory complications. The use of thoracic epidural anesthesia for breast surgery could improve patients recovery and reduce the cost of these procedures.