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. 2023 Jul-Aug;37(4):1412-1422.
doi: 10.21873/invivo.13225.

Awake Breast Surgery: A Systematic Review

Gianluca Vanni  1 , Giacomo Costanzo  1 , Marco Pellicciaro  2   3 , Marco Materazzo  1   3 , Chiara Buonomo  4 , Tacconi Federico  5 , Erica Giacobbi  6 , Francesca Servadei  6 , Lucia Anemona  6 , Annalisa Noce  7 , Mario Dauri  4 , Oreste Claudio Buonomo  1
Affiliations

Awake Breast Surgery: A Systematic Review

Gianluca Vanni et al. In Vivo. 2023 Jul-Aug.

Abstract

Background/aim: Awake surgery has become a valid alternative to general anesthesia in many surgery fields. This technique played a very important role during the COVID-19 period. The growing use of this technique has many advantages. We performed a systematic review to study the potentialities of awake breast surgery.

Materials and methods: We searched Pubmed, Embase, and Cochrane library database and retrieved a total of 109 records. Forty-nine of them were excluded as unsuitable. Finally, we selected a total of 12 records concerning different types of studies for topic appropriateness. Three reviewers reviewed independently each record.

Results: Five articles analyzing the sustainability of awake surgery during the COVID-19 period were selected. In addition, one article analyzing the impact on the immune system and six articles and eight case reports analyzing anesthetic techniques were also selected. The studies analyzing awake breast surgery during the COVID-19 period showed advantages in terms of sustainability and length of hospitalization. The study analyzing the immune response after awake breast surgery showed lesser lymphocyte response than the general anesthesia group. The studies analyzing anesthetic techniques in awake breast surgery showed that the nerve blocks allow good level of safety and postoperative pain control.

Conclusion: The awake breast surgery and fast track implementation shortened hospital stays and reduced costs, without influencing the surgical results. Furthermore, awake breast surgery reduced surgical stress compared to general anesthesia. Among the various anesthetic techniques, nerve blocks are the most advantageous in terms of safety and efficacy compared to epidural anesthesia.

Keywords: Awake breast surgery; awake surgery; review; surgery without patient intubation.

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Conflict of interest statement

The Authors declare that they have no potential conflicts of interest in relation to this study.

Figures

Figure 1
Figure 1. Flowchart of awake breast surgery: systematic review, according to Prisma 2020 guidelines (64).
See this image and copyright information in PMC

References

    1. Cantlon M, Yang S. Wide awake hand surgery. Bull Hosp Jt Dis (2013) 2017;75(1):47–51. - PubMed
    1. Jiam NT, Dwyer CD, Rosen CA. Awake laser laryngeal stenosis surgery. Laryngoscope. 2021;131(5):E1633–E1637. doi: 10.1002/lary.29295. - DOI - PubMed
    1. Ishikawa N, Watanabe G. Ultra-minimally invasive cardiac surgery: robotic surgery and awake CABG. Surg Today. 2015;45(1):1–7. doi: 10.1007/s00595-014-0961-x. - DOI - PubMed
    1. Khattab MFM, Sykes DAW, Abd-El-Barr MM, Waguia R, Montaser A, Ghamry SE, Elhawary Y. Spine surgery under awake spinal anesthesia: an Egyptian experience during the COVID-19 pandemic. Neurosurg Focus. 2021;51(6):E6. doi: 10.3171/2021.9.FOCUS21456. - DOI - PubMed
    1. Conte V, Baratta P, Tomaselli P, Songa V, Magni L, Stocchetti N. Awake neurosurgery: an update. Minerva Anestesiol. 2008;74(6):289–292. - PubMed

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