Choosing anesthesiologist is as important as choosing surgeon

grandma3X

I had a unilateral mastectomy with tissue expander placement 4 days ago and wanted to share my experience. Please note that I AM NOT A HEALTH CARE PROFESSIONAL - be sure to discuss all of this with your surgeon! This regimen should only be followed under the direction of your surgeon and anesthesiologist!

First off, for those of you coming up on surgery, go to the Clinical Trials thread here:

https://community.breastcancer.org/forum/73

And read through the thread on propofol and paravertebral block. There are also threads on opioids used during surgery that are valuable - just search for "opioids".

The gist of these threads is that the anesthesiology regimen used during surgery can have an impact not only on the amount of pain and nausea that you will experience but also on the risk of recurrence of cancer.

A week before my surgery, I contacted my breast surgeon and asked about getting a paravertebral block for regional anesthesia and propofol for general anesthesia. She agreed with both of these requests. (Be sure to specify that you want the paravertebral block before surgery, because they can also be placed after surgery). I also asked to speak with the anesthesiologist but was told that they would not assign one until the day before surgery. I then emailed someone in anesthesiology who immediately put in contact with one of the anesthesiologists who was scheduled to work that day. I discussed my concerns with him and he was actually pleased that I was requesting an opioid-sparing regimen.

I don't have the details of what was done during surgery, but here is what I do know: I was instructed to drink a 20 oz. bottle of Gatorade at least 2 hours before surgery. This is supposed to help tprevent nausea and insulin resistance post surgery. Just prior to surgery, I was given the paravertebral block. This involved injections along the side of my spine to numb the nerves going to my chest. They gave me a light sedative so that it did not bother me too much to have this done. I was then given acetaminophen, Celebrex, and gabapentin before surgery to help with pain. They put a scopolamine patch behind my ear to help with nausea and also used anti-emetics. After transferring to the operating table, I was given a dose of propofol and immediately fell asleep.

I awoke after surgery feeling fine - no nausea, no pain, no fuzzy feeling from anesthesia. When I was released the next day, they wanted to give me a prescription for oxycodone but I asked for Tramadol instead. This is a non-opioid narcotic that has been shown to stimulate natural killer (NK) cell activity. My pain level since surgery has been barely a 1 on a scale of 1-10. I've been able to control any pain with Tylenol and take the Tramadol only at night because it puts me out for 8 hours of sleep and I think that sleep is essential to good recovery.

Today, 4 days post-surgery, I have good range of motion in my arm, no pain, no fuzzy anesthesia brain. Please note that I am taking it very easy - I don't want to risk developing a seroma!However, I don't feel any of the discomfort or tightness that others have noticed from the TE (my plastic surgeon used a TE that is less rigid than the older styles) and the drains are not causing any discomfort or pain.

Feel free to PM me if you would like more details. Overall, I think that having an anesthesiologist who was willing to use an opioid-sparing regimen made a big difference in how I'm feeling today.

grandma3X

Just a side note - I've had painful plantar fasciitis for over a year. It is now completely gone since surgery. I'm not sure why, but I suspect that it had something to do with the compression sleeves on my calves after surgery which increased blood flow to and from my lower extremities.

MelissaDallas

Just be advised that if you are on any kind of blood thinner for other conditions that spinal anesthesia is NOT an option. They cannot risk you beeding into your spinal canal. I could not have this anesthesia for that reason

grandma3X

Thank you Melissa. There are other conditions that would also preclude patients from this regimen. Scopolamine patches can't be used if you have a certain type of glaucoma for example. It's important to talk to your surgeon and anesthesiologist about any potential interactions before surgery.

grandma3X

I'm now 6 weeks post op and wanted to give an update. I still feel great, no residual pain. I've completed 9 sessions of physical therapy and found that this helped immensely with range of motion. My PS used a Mentor CPX4 tissue expander, which she said is a not as stiff as the previous models. It's very comfortable and I forget it's there most of the time, lol. I plan to have a prophylactic mastectomy of the right boob in May, so we shall see if I have the same outcome the second time!

windingshores

I also had a paravertebral block, first for my cancer breast and then a couple of months later for my non-cancer breast. The first time, even though I made it clear that I was having the block to avoid pain meds and reduce anesthesia, I woke up on a dose of dilaudid and they had me on a pump in the hospital room, and I vomited a few times, was out of it, not pleasant.

The second time I made it REALLY clear I didn't want any pain meds and as little anesthesia as possible considering that it is a fairly major surgery. I woke up clear as a bell and stayed that way, and had no pain for maybe 4 days.

I didn't do the scolpamine or anti-nausea or any other drugs at all.

However, both times, for different reasons I DID have quite a bit of pain for a couple of weeks after that initial period covered by the block. I used one half to one of the lowest dose oxycodone pills if I really had to. I think the post-surgery pain levels are highly variable from person to person and surgery to surgery.